title: Necrotizing pulmonary granulomata in a marijuana smoker.
abstract: We describe the case of a heavy marijuana and tobacco smoker who presented with progressive exertional dyspnea of 2 months' duration, and bilateral nodular lung infiltrates. Examination of the lung fields was normal, and lung function tests showed mild airflow obstruction with moderately reduced gas transfer. BAL returned green-black fluid consisting predominantly of macrophages laden with carbon pigment. Thoracoscopic lung biopsy showed miliary necrotizing granulomata with an alveolar exudate of carbon-laden macrophages within macroscopically blackened lung. The differential diagnosis of pulmonary granulomata in this patient is discussed.
authors.affiliation: Department of Respiratory Medicine, Western Hospital, Melbourne, Australia. david.cunnington@nwhcn.org.au
authors.forename: D
authors.initials: D
authors.lastname: Cunnington
authors.forename: H
authors.initials: H
authors.lastname: Teichtahl
authors.forename: J M
authors.initials: JM
authors.lastname: Hunt
authors.forename: C
authors.initials: C
authors.lastname: Dow
authors.forename: R
authors.initials: R
authors.lastname: Valentine
mesh_terms: D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002244:Carbon; D005260:Female; D015769:Granuloma, Respiratory Tract / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology* / Q000473:pathology; D016676:Macrophages, Alveolar / Q000473:pathology; D008385:Marijuana Smoking / Q000009:adverse effects* / Q000473:pathology; D009336:Necrosis
chemical_list: D002244:Carbon