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

Preuß, J.; Woenckhaus, Christian; Thierauf, Annette; Strehler, M.; Madea, Burkhard

doi:10.1016/j.forsciint.2008.05.006

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…In a study conducted in Turkey, tuberculosis was found to be the most common cause of infectious reasons for fever of unknown origin (19). Tuberculosis has even been considered in the differential diagnosis of arthritis and of malignancies due to M. tuberculosis complex, which causes granulomatous lesions (15,(20)(21)(22). In light of these data, pulmonary tuberculosis patients, who are the main source of new pulmonary or extrapulmonary tuberculosis cases, should be diagnosed immediately.…”

Section: Discussionmentioning

confidence: 99%

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Çelik¹,

Gözel²,

Bakıcı³

et al. 2015

Turk J Med Sci

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The aim of this study is to assess the Xpert MTB/RIF assay for diagnosis of the Mycobacterium tuberculosis complex in clinical samples and to compare the results by reference to the diagnostic method, Bactec MGIT 960. Materials and methods:A total of 7407 samples were included from patients not primarily suggesting pulmonary or extrapulmonary tuberculosis (TB), collected from patients required to be screened for TB and excluding TB diagnoses since it was a differential diagnosis. Also included were a total of 411 samples from patients primarily suggesting pulmonary or extrapulmonary TB.Results: In the first group, 152 of 7407 samples yielded positive results with the Bactec MGIT 960, 131 (1.77%) were found positive with Löwenstein-Jensen medium, and 295 (3.99%) were found positive with Ziehl-Neelsen staining. In the second group, 24 (5.8%), 17 (4.1%), and 28 (6.8%) of 411 samples were found positive. Xpert MTB/RIF [27 (6.6%) of 411 samples] detected 3 additional samples as positive, and these 3 cases were clinically compatible with TB. Conclusion:The Xpert MTB/RIF assay shows superior performance for the diagnosis of TB. Its usefulness in culture-negative patients and the best method for integrating this diagnostic method into current tuberculosis diagnostic algorithms both need further study.

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Section: Discussionmentioning

confidence: 99%

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Çelik¹,

Gözel²,

Bakıcı³

et al. 2015

Turk J Med Sci

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“…Among the 135 cases, 9 patients died during follow-up (7%). Two deaths 38,67 were related to PHG. One of the patients died after 30 years of interstitial lung disease and PHG diagnosis was made after autopsy 38 .…”

Section: Respiratory Functionmentioning

confidence: 99%

“…One of the patients died after 30 years of interstitial lung disease and PHG diagnosis was made after autopsy 38 . The second patient died after compression of the right cardiac cavity by a lung nodular lesion 67 . The other causes of deaths were infectious pneumonia (n =4) 26,34,52,60 , acute hemolytic anemia (n=1) 10 refractory mediastinal fibrosis (n= 1, case 1) and myeloma (n = 1) 7…”

Section: Respiratory Functionmentioning

confidence: 99%

Pulmonary hyalinizing granuloma: a multicenter study of 5 new cases and review of the 135 cases of the literature

et al. 2016

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Pulmonary hyalinizing granuloma (PHG) is a rare disease characterized by single or multiple benign lung nodules mimicking lung neoplasma. Histologic analysis reveals homogenous hyaline lamellae, usually surrounded by collection of plasma cells, lymphocytes and histiocytes in a perivascular distribution. The clinical and radiological findings have been described in small series, but the long-term outcomes have rarely been reported. The objectives were to describe the clinical, radiological and outcomes of PHG in new cases and through a literature review. Patients with PHG were found by a multicenter search among French departments of internal medicine, pulmonology and anatomo-pathology. Review of the literature was made through the National Library of Medicine's MEDLINE database using keywords "hyalinizing granuloma." Five news cases and 135 cases of the literature were found. There were 82 men and 57 women, mean age at the diagnosis 44.6 years (15-83). Patients were frequently asymptomatic (n = 39, 27.4 %). The nodule was unique in 37 cases (28.9 %) and multiple in 91 cases (71.1 %). 18FDG PET scan revealed hypermetabolism of the nodule in 9/15 cases (60 %). A systemic disease was associated in 65 cases (mainly mediastinal and retroperitoneal fibrosis, autoimmune, tumoral or infectious disease or thromboembolism). The outcomes were evaluated in 73 patients when follow-up was available: 14 patients had a surgical resection of the nodule. Forty-five patients did not receive any immunosuppressive drug. Among these patients, 2 improved, 29 were stable and 14 worsened. Corticosteroids were used as a monotherapy in 19 patients and led to radiological improvement in 8 cases, stabilization in 8 cases and worsening in 3 cases. Five patients were treated with corticosteroids and at least one immunosuppressive drug and 4 patients improved. PHG is a rare benign disease, mimicking lung neoplasma, frequently associated with systemic diseases.

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“…Hyalinizing granuloma has also been related to certain immunological diseases, such as rheumatoid arthritis, sclerosing mediastinitis, retroperitoneal fibrosis, and uveitis, as well as to infectious diseases, such as tuberculosis, histoplasmosis, and aspergillosis. (6)(7)(8) Patients with pulmonary hyalinizing granuloma can be asymptomatic, in which case suspicion of the disease is raised by radiological findings, or can present with dry cough, dyspnea, nonspecific chest pain, fatigue, and hemoptysis. (9) The diagnosis is based on anatomopathological examination, the microscopic aspects of which indicate thick deposits of collagen (keloid-like lesions) arranged concentrically or irregularly distributed, presenting central hyalinization and supplanting the lung parenchyma.…”

Section: Case Reportmentioning

confidence: 99%

“…At the interface between the lesion and the adjacent parenchyma, there is an increase in cellularity, together with the presence of lymphoplasmacytic inflammatory cells; in addition, there can be formation of lymphoid aggregates and foreign body granulomas. (2,8) There have been reports of extrapulmonary manifestations affecting the kidneys, larynx, and skin. (9,10) In the case reported here, the patient presented with skin involvement, characterized by a subcutaneous nodule.…”

Section: Case Reportmentioning

confidence: 99%

Granuloma hialinizante de pulmão recidivante

Arruda

Carvalho

Andrade³

et al. 2010

J. bras. pneumol.

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Relatamos o caso de um paciente de 61 anos, masculino, internado com objetivo de exérese de massa pulmonar para estudo anatomopatológico. O paciente apresentara anteriormente um quadro de febre, tosse seca e dor torácica, associado à presença de massas pulmonares detectadas por radiografia de tórax, tendo sido submetido em duas ocasiões (1976 e 1981) a toracotomia para a investigação diagnóstica, sem diagnóstico anatomopatológico conclusivo. A TC de tórax revelou volumosas massas com áreas de calcificação em ambos os campos pulmonares. O material do estudo anatomopatológico foi compatível com granuloma hialinizante de pulmão. No pós-operatório, o paciente apresentou vários episódios de broncoespasmo que foram revertidos com medicação sintomática. Foi mantido com prednisona na dose de 40 mg/dia com boa evolução clínica até o envio deste relato.

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

Cited by 5 publications

References 26 publications

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Applicability of Xpert MTB/RIF assay for routine diagnosis of tuberculosis: a four-year single-center experience

Pulmonary hyalinizing granuloma: a multicenter study of 5 new cases and review of the 135 cases of the literature

Granuloma hialinizante de pulmão recidivante

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