Granülomatöz Hastalýklarda Ne, Nerede ve Nasýl?

Akciðerin granülomatöz hastalýklarý patolojik ve klinik açýdan ayýrt edici tanýsý zor olabilen durumlardýr. Enfeksiyon dýþý nedenlerden sarkoidoz, hipersensitivite pnömonisi ve enfeksiyöz olarak ise tüberküloz en sýk görülenleridir. Burada granülomatöz akciðer hastalýðý olup ayýrt edici tanýlarýnda zorluk yaþanan olgular uzun süreli takipleriyle sunuldu. Birinci olgu 64 yaþýnda kadýn hasta, klinik ve radyolojik olarak hipersensitivite pnömonisi ve ikinci olgu ise 67 yaþýnda erkek hasta, patolojik olarak sarkoidoz ön tanýlarý konularak kortikosteroid kullanmaktaydý. Ancak, kortikosteroid altýnda klinik ve radyolojik progresyon olmasý üzerine yeniden tanýsal araþtýrma yapýldý. Tekrarlanan bronkoskopik örneklemelerle ve farklý (PCR/BACTEC) tüberküloz kültürü yöntemleri kullanýlarak Mycobacterium tuberculosis üremesi olmasý ile akciðer tüberkülozu tedavisi verildi. Sonuç olarak, bu olgular granülomatöz hastalýklarýn klinik, radyolojik ve patolojik açýdan benzerlik gösterebileceðini ve ayýrt edici tanýda tüberküloz mikrobiyolojik tetkik tekrarýnýn önemini göstermesi açýsýndan ilginçtir.

What, Where and How in Granulomatous Diseases?

Granulomatous diseases of the lung may be difficult to diagnose in both pathological and clinical aspects. The most common reasons for granulomatous lung are tuberculosis as an infectious source, and sarcoidosis or hypersensitivity pneumonia (HP) as non-infectious causes. Here, 2 cases of granulomatous lung disease that had been incorrectly diagnosed are described. The first was a 64-year-old female patient diagnosed as HP clinically and radiologically, and the second was a 67-year-old male diagnosed as sarcoidosis pathologically. Both had progression clinically and radiologically under corticosteroid treatment. Repeat bronchoscopic evaluation revealed Mycobacterium tuberculosis in the bronchial lavage polymerase chain reaction/BACTEC (Becton Dickinson and Co., Franklin Lakes, NJ, USA) cultures, and lung tuberculosis treatment was initiated for both patients. These cases are interesting in that granulomatous diseases may have similarities in clinical, radiological, and pathological features, and repetition of tuberculosis microbiological examination is important in the differential diagnosis.

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