Bronchocentric granulomatous disease

Introduction to bronchial central granulomatosis Bronchcentric granulomatosis (BG) is an immune disease in which patients can be divided into those with and without asthma. The etiology of BG may be associated with an immune response to certain Aspergillus parasitic in the bronchi in patients with asthma, and non-asthmatic patients may be associated with hypersensitivity reactions caused by inhalation of unknown antigens. The prominent feature of pathology is non-caseal granuloma rich in eosinophils. The early bronchiole mucosa was replaced by tissue cells, and then non-caseous and necrotizing granuloma were distributed in the bronchioles and destroyed. In the asthma group, more eosinophils were seen in the lesions; For plasma cells. Special staining revealed fungal hyphae in the granuloma, vasculitis in the pulmonary artery and vein adjacent to the granuloma, but unlike the WG, there was no destruction of the vascular center, the bronchus was dilated, and there was a tough gray-brown layered substance in the cavity. Mucus, necrotic epithelium, inflammatory cells, eosinophils, and Charcot-Ley-den crystals can be seen, and fungal hyphae can be found. There may be eosinophils and chronic inflammatory cell infiltration around the bronchi, accompanied by fibrosis. A few patients have bronchial submucosal necrotizing granuloma nodules and can destroy tracheal cartilage. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: atelectasis

Causes of bronchial central granulomatosis

(1) Causes of the disease

The etiology of BG may be associated with an immune response to certain Aspergillus parasitic in the bronchi in patients with asthma, and non-asthmatic patients may be associated with hypersensitivity reactions caused by inhalation of unknown antigens.

(two) pathogenesis

The prominent feature of pathology is non-caseal granuloma rich in eosinophils. The early bronchiole mucosa is replaced by tissue cells, and then non-cheese, necrotizing granuloma is distributed in the bronchioles and destroyed, in asthma. In the group, more eosinophils were seen in the lesions; in the non-asthmatic group, most of the lesions were plasma cells, and special staining showed fungal hyphae in the granuloma, and vasculitis in the pulmonary artery and vein adjacent to the granuloma, but with WG Different, avascular center is destroyed, the bronchus is dilated, and there is a tough gray-brown layered substance in the cavity. Mucous, necrotic epithelium, inflammatory cells, eosinophils and Charcot-Ley-den crystals can be seen under the microscope, and fungi can be found. Hyphae, there may be eosinophils and chronic inflammatory cell infiltration around the bronchi, accompanied by fibrosis, a small number of patients have bronchial submucosal necrotizing granuloma nodules, and can destroy tracheal cartilage.

Prevention of bronchial central granulomatosis

1. The cause is unknown, so effective preventive measures must be explored. However, adrenocortical hormone is still the drug of choice at present, and reducing the dose without affecting treatment can greatly reduce the incidence of opportunistic infection.

2. Diabetic patients may be exacerbated by hormones and should be used with caution.

Bronchial central granulomatosis complications Complications of atelectasis

Complicated with atelectasis is more common.

Symptoms of bronchial central granulomatosis common symptoms fatigue chest pain granuloma shortness

Most patients have asthma. Patients in the asthma group usually develop from a young age. Most of them are specific to the body. They often have a family history of asthma. The onset is more urgent, often with fever, cough, and most of the mucus purulent, sometimes brownish mucus. Sputum, some patients with shortness of breath and chest pain, no asthma group, the age of onset is relatively large, an average of 50 years old, mild symptoms, mild cough, fatigue, upper respiratory tract infection, etc., no performance of extrapulmonary vasculitis, a few even Asymptomatic.

Examination of bronchial central granulomatosis

1. Hematological examination of peripheral blood eosinophils increased, often exceeding 5 × 109 / L.

2. The total number of white blood cells and erythrocyte sedimentation rate in the acute phase can also be increased.

3. 50% of sputum culture can be found to grow Aspergillus.

4. Skin immunology test Aspergillus mixed extract skin test, 90% of active patients showed positive wheal and flushing reaction within a few minutes, and the serum IgE level was often more than twice that of normal people.

5. X-ray chest radiographs often show infiltrative shadows, single or multiple nodules and atelectasis.

Diagnosis and identification of bronchial central granulomatosis

diagnosis

The pathological manifestation is that non-caseous granuloma rich in eosinophils is located in the bronchioles. The patient has asthma and specific constitution, mucus plug in the bronchi, and eosinophils in the surrounding blood and tissues. High sensitivity, central bronchiectasis, pulmonary infiltration, increased IgE levels, etc., all contribute to the diagnosis of BG, but must exclude fungi, tuberculosis infections, rheumatoid nodules and other vasculitis and granulomatosis.

Differential diagnosis

Fungi, tuberculosis infections, rheumatoid nodules and other vasculitis and granulomatosis must be excluded.

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