Granulomatous Diseases of the Lung

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Some progressive lung diseases are characterized by the presence of histiocytic and giant-cell
granulomatous inflammatory responses. The most important are TB caused by tuberculosis), sarcoidosis,
granulomatous vasculitis, and fungal infections, e.g. histoplasmosis.
Granulomas also develop as a response to some foreign bodies in the lung, e.g. in some pneumoconioses
such as chronic berylliosis, and in response to some inhaled allergens. TB is discussed in Chapter 5.

Sarcoidosis causes granulomatous inflammation of the lung with interstititial fibrosis.
A multisystem disease of unknown cause, sarcoidosis is characterized by the presence of non-caseating
granulomas in tissues. From the histology it is evident that a Type IV immune response takes place,
yet no allergen or infective organism has been conclusively demonstrated. In 90% of cases the main
tissues involved are those of the lungs and draining hilar lymph nodes.
Sarcoidosis is also discussed in Chapter 23.
Patients with lung involvement present with slowly progressive dyspnoea and cough, and are found to have
lung shadowing on chest radiograph, with enlargement of hilar lymph nodes.
Histology shows non-caseating histiocytic granulomas in the lung interstitium.
Around 70% of patients recover with steroid therapy; 25% of patients show progression to interstitial
fibrosis and development of honeycomb lung.

Asbestos bodies are long, thin asbestos fibres coated with haemosiderin and protein to form brown
filaments with a beaded or drumstick pattern.
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We give here simplified and accurate information about the disease

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Revised: 12-10-2014.