Immunologic Abnormalities in Two Patients with Pulmonary Hyalinizing Granuloma

Abstract

Pulmonary hyalinizing granuloma (PHG) is a disease of slowly enlarging pulmonary nodules made up of dense bundles of collagen accompanied by an infiltrate of chronic inflammatory cells. The etiology is unknown. Although it has been suggested that the lesions represent an exaggerated immune response to unidentified agents, results of a detailed immunologic work-up of these patients have not been published. This report presents the laboratory findings of two patients with biopsy-proven PHG who have been followed four and eighteen years. Autoantibodies were detected (antinuclear antibody, rheumatoid factor, and positive antiglobulin tests), although clinically there was no evidence of a specific collagen-vascular disorder. Both patients had elevated levels of circulating immune complexes. These data suggest that immune complex mechanisms may be important in the pathogenesis of PHG.

Non-diagnosed pulmonary hyalinizing granuloma (PHG) as a cause of sudden unexpected death

“…hypersensitivity reaction to insoluble lipids and circulating immune complexes in the pathogenesis of PHG [6,28,33,40].…”

A Case of Pulmonary Hyalinizing Granuloma Associated with Posterior Uveitis

“…There is theoretical consideration of a possible strong antigenic challenge that produces a chronic immune response, which provokes the development of PHG nodules. Up to 60% of patients with PHG reported have serologic evidence of an autoimmune disorder including antinuclear, antismooth muscle antimicrosomal or antithyroglobulin antibodies and rheumatoid factor (Schlosnagle et al 1982;Ren et al 2001). However, it remains unclear whether autoimmunity is a predisposing factor or a consequence of PHG.…”

A case of steroid responsive pulmonary hyalinising granuloma: complicated by deep venous thrombosis

“…Support for this hypothesis has come from the demonstration of a variety of auto-antibodies in sera of patients with PHG. To date, there have been reports of anti-antinuclear antibodies, rheumatoid factor, anti-neutrophil cytoplasmic antibodies, anti-smooth muscle antibodies, anti-microsomal antibodies and Coomb9s-positive haemolytic anaemia [2,5]. In addition, circulating immune complexes have been demonstrated.…”