case_images: PMC11199689_01
case_images: Clinical and treatment course. X indicated the day of bronchoscopic examination was performed, and X-10M indicated the day of 10 month (M) before the day of bronchoscopic examination was performed. Changes in serum levels of angiotensin converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R) were in blue line and red-dot line, each. PIP, proximal interphalangeal; MP, metacarpophalangeal; MTX, Methotrexate.
case_images: fmed-11-1380236-g001.jpg
case_images: PMC11199689_01_fmed-11-1380236-g001.jpg
case_images: F1
case_images: He had been having dry cough for 3 months before bronchoscopic examination (the day X-3M) (Figure 1), and painful swelling of the right knee and right wrist, and diffuse tiny scaly erythematous in abdomen, back and extremities of cutaneous with mild pigmentation, were accompanied with emergence of cough. Bronchoscopy was performed on the lesions of the lung field and mediastinal lymph nodes on day X (Figure 1). Changes in serum angiotensin converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R) levels appeared to reflect well the manifestation of cough and lung lesions and their subsequent resolution (Figure 1).
case_images: (A) Chest computed tomography using the lung window setting shows diffuse ground-glass shadows presumed to be fine nodules in the bilateral upper lobes, (B) middle and lingular lobes, (C) and bilateral lower lobes. (D) Chest computed tomography using the mediastinum window setting shows minor swelling of mediastinal lymph nodes, indicated by white arrows.
case_images: fmed-11-1380236-g002.jpg
case_images: PMC11199689_01_fmed-11-1380236-g002.jpg
case_images: F2
case_images: Chest X-rays and CT scans showed diffuse fine granular shadows extending into the bilateral lungs (Figures 2A-C) and minor swelling of the mediastinal lymph nodes (Figure 2D).
case_images: (A) Histological examinations of the lung tissue obtained by transbronchial lung cryobiopsy show non-caseating epithelioid granulomas scattered around the alveolar septum, bronchi, vessels and large complex of granulomas without inter granulomatous sclerosis at X30 magnification, black scale bar = 1mm. (B) Prominent epithelioid cells and multinucleated giant cells around bronchioles are indicated by black arrows in the panel at X200 magnification, black scale bar = 100 mum.
case_images: fmed-11-1380236-g003.jpg
case_images: PMC11199689_01_fmed-11-1380236-g003.jpg
case_images: F3
case_images: In the present case, specimens obtained by TBLC were sufficiently large to observe complex of granulomas and inter granulomas, and those specimens showed non-caseating epithelioid granulomas scattered around the alveolar septum, bronchi, and vessels forming a large granulomatous complex without inter granulomatous sclerosis at low magnification (Figure 3A). At high magnification, prominent epithelioid cells and multinucleated giant cells around bronchioles were observed, similar to previous reports on polycyclic granuloma observed in lymph nodes or skin biopsy specimens from BS patients, but in the present case, they were not seen in granulomas with dense lymphocytic coronas (Figure 3B).