Clinical Analysis Of 123 Cases Of Granulomatous Lung Disease

Objective: To provide a reference for the diagnosis of granulomatous lung disease by analyzing the clinical data of patients with granulomatous lung disease.Methods: 123 cases of granulomatous lung disease confirmed by lung biopsy in the first affiliated hospital of Guangxi Medical University were analyzed retrospectively from July 1,2018 to June 30,2019,which including the general data,clinical symptoms,pulmonary imaging features,laboratory examinations,pathological features and etiological results.Results: 1.Among the 123 patients with granulomatous lung diseases in this study,28(23%)were diagnosis by percutaneous lung biopsy,46(37%)by fiberoptic bronchoscopic biopsies,10(8%)by open lung biopsies and 39(32%)by thoracoscopic biopsy.Of the 123 patients,84(68%)were finally diagnosed infectious diseases,of which 56(45%)were tuberculosis,2(2%)non-tuberculous mycobacteria(NTM)lung diseases,13(10%)pulmonary cryptococcosis,6 cases(5%)of pulmonary aspergillosis,6(5%)of talaromycosis marneffei(TSM)and 1(1%)of pulmonary nocardiosis.Among them,11(9%)were finally diagnosed non-infectious diseases,including 5(4%)of granulomatosis with polyangiitis(GPA),1(1%)of Eosinophilic granulomatosis with polyangiitis(EGPA),4(3%)of arthritis and 1(1%)of cholesterol pneumonia.In addition,28 cases(23%)were unknown etiology.2.The average age of 123 patients was(51.7±13.3)years old,including 73 males(59.3%)and 50 females(40.7%).There were 39 patients(31.7%)with smoking and 84 patients(68.3%)without smoking.There was no statistically significant difference in gender,age and smoking history of each group(P>0.05).The underlying diseases in the infectious disease group were more common than those with unknown etiology(P=0.003).3.Cough was the most common symptom of granulomatous lung disease,of which 84 cases(68.3%)had cough symptoms.There was no significant difference between intrapulmonary and extrapulmonary symptoms with fever,night sweats and weight loss in each group(P > 0.05).The difference of asymptomatic between infectious disease group and unknown etiology group was statistically significant(P= 0.016).4.The distribution and morphological characteristics of the lesions were various at Chest CT imaging.The infectious disease group,non-infectious disease group,and unknown etiology group have statistically significant differences in the lesions involving the middle lobe of the right lung,morphological consolidation shadows,ground glass shadows,patch cord shadows and lesion borders(P <0.05).5.Among the etiological results of 56 patients with tuberculosis,7 of 33 were positive for acid-fast bacilli on sputum smear test,and all 33 were negative for acid-fast bacilli culture;8 of the 42 cases were found to be acid-fast bacilli by bronchoalveolar lavage fluid smear,the culture of BALF acid-fast bacilli in42 cases was negative,mycobacterium tuberculosis was detected by the next generation sequencing technology in BALF of only 1 case;mycobacterium tuberculosis could be cultured in 2 of 10 cases of lung tissue culture,and 5 cases of pleural effusion were negative.6.Among the pathological features,38 cases(67.9%)of 56 cases of pulmonary tuberculosis were infected with granulomatous necrotizing granuloma,of which 30 cases were caseous necrosis,8 cases showed Langerhans giant cells,and only 4 cases were positive for acid-fast staining.In 13 cases of cryptococcal granuloma,12 cases(92.3%)were non-necrotizing granuloma,2 cases(15.4%)showed fungal spores under microscope,13 cases were positive for PAS staining and 2 cases were positive for GMS staining.Of the 11 cases of non-infectious disease granuloma,8 cases(72.7%)were non-necrotizing granuloma.There was a significant difference in the presence or absence of necrotizing granuloma between the unknown etiology group and the infectious disease group(P=0.016).There was significant difference between necrotizing and non-necrotizing granuloma between mycobacteria group and fungal group in infectious disease group(P=0.001).7.28 patients with unknown etiology were followed up to May 23,2020,only one patient was diagnosed with pulmonary tuberculosis,and the other 27 patients were still of unknown etiology.Conclusions: 1.Fiberoptic bronchoscopic biopsy was the most common method for lung tissue biopsy in patients with granulomatous lung disease.Infection was the most common cause of granulomatous pulmonary disease.The most common pathogens were mycobacterium tuberculosis and Cryptococcus.2.The basic diseases in the infectious disease group were more common than those in the unknown etiology group.Cough was the most common clinical symptom of granulomatous lung disease.Pulmonary manifestations and symptoms such as fever,night sweats and weight loss were not specific in each group,but asymptomatic in the unknown etiology group was more common than that in the infectious disease group.3.In the chest CT imaging manifestations,the lesions involving the middle lobe of the right lung were more common in the non-infectious disease group and the unknown etiology group than in the infectious disease group.The solid shadow in the unknown etiology group was more common than that in the infectious disease group.The patch cord shadows was more common in the non-infectious disease group than in the non-infectious disease group.The lesions with unknown etiology were mostly with clear boundary,while the infectious disease group and the non-infectious disease group were mostly with unclear boundary.4.The pathology of infectious diseases was mainly necrotic granuloma,and the non-infectious diseases were mainly non-necrotic granuloma.The granuloma tissues of unknown etiology were also mostly non-necrotic.Mycobacterial infections in the infectious disease group Granulomas were mostly necrotizing,and fungal infections were non-necrotic.5.In about one-fifth of cases of granulomatous lung disease,pathologic examination may not determine the cause and a combination of clinical and other tests may be necessary.