- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
Bronchocentric granulomatosis is a destructive, granulomatous lesion of the bronchi and bronchioles that is generally believed to represent a nonspecific response to a variety of types of airway injury [1-3]. Approximately half of all cases are associated with asthma and allergic bronchopulmonary aspergillosis (ABPA), and among these patients, bronchocentric granulomatosis may represent a histopathologic manifestation of fungal hypersensitivity [3-7]. (See "Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis".)
The remaining cases of bronchocentric granulomatosis are usually idiopathic, although associations with mycobacterial and fungal infection, rheumatologic disease, granulomatosis with polyangiitis (Wegener’s), chronic granulomatous disease, glomerulonephritis, scleritis, diabetes insipidus, red cell aplasia, pulmonary echinococcosis, bronchogenic carcinoma, and influenza A virus have been reported (table 1) [3,8-24].
Because of the lack of a clear clinical syndrome associated with bronchocentric granulomatosis, the presence of this lesion should generally be considered a nonspecific manifestation of lung injury, not an etiologic diagnosis.
An overview of bronchocentric granulomatosis will be presented here. Pulmonary lymphomatoid granulomatosis, a different clinicopathological entity usually related to Epstein-Barr virus-associated lymphoma, and an approach to an adult with suspected interstitial lung disease, are discussed separately. (See "Pulmonary lymphomatoid granulomatosis" and "Approach to the adult with interstitial lung disease: Clinical evaluation" and "Approach to the adult with interstitial lung disease: Diagnostic testing".)
The incidence and prevalence of bronchocentric granulomatosis are unknown. Bronchocentric granulomatosis is often divided clinically into two groups of patients based upon the presence or absence of asthma [1,2,5]. Patients with asthma tend to be younger (ages 20 to 40) and generally present with pulmonary symptoms such as cough, dyspnea or pleuritic chest pain. Additional features consistent with allergic bronchopulmonary aspergillosis (ABPA) may be seen, ie, fever, malaise, expectoration of brownish mucus plugs (picture 1) . The nonasthmatic group is made up primarily of older patients, ranging in age from 30 to 70. Chest symptoms are rare, and nonspecific fatigue and malaise are more common.
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