Eosinophilic granulomatous

Antithyroid drugs, especially propylthiouracil, can be associated with the development of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis, often manifesting as renal disease. Atypical presentations, with pulmonary capillaritis (58) and lupus-like syndrome (59), have been described in individual cases. Furthermore, two cases of vasculitis have been associated with carbimazole, one presenting with eosinophilic granulomatous vasculitis localized to the stomach (60) and another with p-ANCA positive vasculitis causing simultaneous acute renal insufficiency and massive pulmonary hemorrhage (61). 

Seve P, Stankovic K, Michalet V, Vial T, Scoazec JY, Broussolle C. Carbimazole induced eosinophilic granulomatous vasculitis localized to the stomach. J Intern Med 2005 258(2) 191-5. 

Chronic granulomatous disease is a rare inherited disorder characterized by the failure of neutrophils, eosinophils, monocytes and macrophages to produce the respiratory burst (Curnutte and Babior, 1987) this leads to recurrent bacterial and fungal infections often starting within the first year of life. 

Immunological reactions to cromoglicate can involve the pericardium, the lung, the eye, the nasal mucosa, the skin, the joints, and the liver. Rarely, a hypersensitivity reaction can cause fever (4). A survey of the world literature up to 1982 found 13 cases of facial rash, urticaria, and/or generalized dermatitis, and one of nasal congestion. In 19 patients there was bronchospasm and/or pulmonary edema, eventually culminating in shock. Four cases of eosinophilic or granulomatous pulmonary infiltration, one of liver disease and vasculitis, one of pericarditis, and three of polymyositis were reported. 

Bjornsson E, Olsson R, Remotti H. Norfloxacin-induced eosinophilic necrotizing granulomatous hepatitis. Am J Gastroenterol 2000 95(12) 3662. ... 

Michielsen C, Leusink-Muis A, Vos JG, Bloksma N (2001) Hexachlorobenzene-induced eosinophilic and granulomatous lung inflammation is associated with in vivo airways hyperresponsiveness in the Brown Norway rat. Toxicol Appl Pharmacol, 172 11-20. 

Michielsen C, Zeamari S, Leusink-Muis A, Vos J, Bloksma N (2002) The environmental pollutant hexachlorobenzene causes eosinophilic and granulomatous inflammation and in vitro airways hyperreactivity in the Brown Norway rat. Arch Toxicol, 76 236-247. 

Figure 11.6 Overview of the lung section of (a) control rat and (b) rat exposed to 2.5 mgm MWCNT. (c) is a detail view of focal granulomatous inflammation observed in a rat exposed to 0.1 mg m MWCNT, and (d) in a rat exposed to 2.5 mg m" MWCNT. (e) Lung section of a rat exposed to 2.5 mg m showing intra-alveolar eosinophilic granular material which was diagnosed as lipoproteinosis. (f) This intra-alveolar eosinophilic granular material was PAS-positive. Reproduced from L. Ma-Hock et aL, Inhalation toxicity of multiwall carbon nanotubes in rats exposed for 3 months, Toxicol. Sci, 2009,112, 2, with permission from Oxford University Press. ...

Granulomatous pulmonary foci with lymphoid fol-Hcles, round folHcular groups of histiocytes, and a patchy infiltration of eosinophils and much well advanced fibrous tissue had developed in a 33-year-old male who had worked as a precision grinder, grinding a hard metal compound (stellite) with a silicone carbide wheel and without any exhaust ventilation (Joseph 1968). The chemical analysis of the lung biopsy showed only titanium, but no tungsten or cobalt. 

Skin An interstitial granulomatous reaction to anakinra resulted in pink dermal plaques and nodules in the periaxillary region which resolved after withdrawal of anakinra and recurred on rechaUenge [82 ]. Biopsy showed diffuse dermal infiltration of lymphocytes and histiocytes with interspersed neutrophils and eosinophils, and... 

Eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small- to medium-sized vessels, and associated with asthma and blood eosinophilia... 

According to the Chapel Hill Consensus Conference on the nomenclature of systemic vasculitis (84), CSS belongs to the group of antineutrophil cytoplasmic antibodies (ANCA)-associated smaU-vessel vasculitis and is defined as an eosinophil-rich and granulomatous inflammation involving the respiratory tract, with necrotizing vasculitis affecting small- to medium-sized vessels, and associated with asthma and eosinophiha. 

The vasculitis is similar to that of classic polyarteritis nodosa. The characteristic histopathological features are granulomatous reactions, vdiich are present in the tissues or even within the vessel walls. These are usually associated with infiltration of the tissues with eosinophils. 

---