A case of pulmonary lymphomatoid granulomatosis with difficulty in diagnosis

• Published in: The Journal of the Japanese Association for Chest Surgery Vol. 37; no. 1; pp. 64 - 68
• Main Authors: Yamamoto, Kozo, Kuwahara, Motohisa, Yamamoto, Satoshi, Takase, Yukari, Takeshita, Morishige
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Association for Chest Surgery 15.01.2023
• Subjects: diffuse large B-cell lymphoma; Epstein-Barr virus; lymphomatoid granulomatosis
• ISSN: 0919-0945; 1881-4158
• DOI: 10.2995/jacsurg.37.64

A 69-year-old man with left chest pain consulted a previous hospital. Chest computed tomography (CT) revealed a 9-cm tumor in the lower lobe of the left lung. The serum level of IL-2R -a tumor marker- was high (1310 U/mL). Transbronchial biopsy was performed, but it did not lead to any definitive diagnosis. A blood test showed an inflammatory response. Suspecting a pulmonary abscess, antibiotic therapy was initiated. CT performed a month later revealed a larger tumor and complete atelectasis of the left upper lobe. The patient was admitted to our hospital. We planned an operation for diagnosis and treatment. We eventually performed biopsies due to adhesion around the hilus of the lung. The histological diagnosis was EBV-positive pulmonary LYG. The patient received chemotherapy corresponding to that administered for diffuse large B-cell lymphoma and achieved a partial response and re-expansion of the left upper lobe. The IL-2 level has been normal since (421 U/mL).Clinicians should be aware of LYG when suspected cases of lung abscess show no improvement despite antibiotic administration.