A double-edged sword

Abstract

In medicine, not everything is what it seems and sometimes you need all the pieces of the puzzle in order to complete the diagnosis. This is a case of a disease with two different faces and a review of its respiratory impact. https://bit.ly/2SDKwE5.

Figure 1

a) Posteroanterior and b) lateral chest radiography showing a diffuse reticulonodular pattern with slight apicobasal gradient and normal cardiac silhouette.

Figure 2

a) Contrast-enhanced chest CT parenchymal window. b) High-resolution CT during inspiration.

Figure 3

FDG-PET, maximum intensity projection. Diffuse supra- and infra-diaphragmatic distribution of FDG-avid adenopathies with increased captation of the spleen. Diffuse FDG-avid lesions spread in the lung parenchyma.

Figure 4

a) Overview of lymph node excision biopsy showing follicular hyperplasia (arrows) and granulomas (arrowheads). b) Detail of multiple, large secondary reactive germ centres of variable shape and size (arrows). Scale bar=100μm. c) Detail of the sinus of the lymph node with a sharply delineated granuloma consisting of multinucleated giant cells and histiocytes.

Figure 5

a) High-resolution computed tomography in inspiration during follow-up (interval: 9-years). b) Follow-up CT with disappearance of ground-glass opacities with progression towards a reticular interstitial pattern.