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Granulomatous and lymphocytic interstitial lung disease
  1. Jenny A Shih1,
  2. Rory K Crotty2,
  3. Amulya Nagarur3
  1. 1 Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Jenny A Shih, Harvard Medical School, Boston, MA 02115, USA; jenny_shih{at}hms.harvard.edu

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Case

A middle-aged woman with common variable immunodeficiency (CVID) presented with progressive dyspnoea and fevers. She had a temperature of 38.9°C, oxygen saturation of 91% on room air and decreased breath sounds at the lung bases. Her lab showed pancytopaenia. Chest CT revealed diffuse ground-glass opacities, hilar and mediastinal lymphadenopathy, and right lower lobe consolidation (figure 1). She received empiric broad-spectrum antibiotics without improvement. An infectious work-up and lymph node biopsy were unremarkable. Bronchoscopy with transbronchial biopsy showed dense bronchial wall lymphoid infiltrates with non-caseating granulomas (figure 2). Bacterial, mycobacterial, fungal and …

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Footnotes

  • Contributors All authors participated in the preparation of the manuscript. JAS and AN planned the write-up. JAS wrote the manuscript. AN and RKC helped edit the manuscript. RKC provided the pathology images and figure legends.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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