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Presented by Fred Askin, M.D. and prepared by Kara Judson, M.D.
Case 6: Forty-five year old man, a farmer, with multiple patchy infiltrates in the lungs.
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1. Question
Week 233: Case 6
Forty-five year old man, a farmer, with multiple patchy infiltrates in the lungs.images/72505 case 6 2.jpg
images/72505 case 6 3.jpg
images/72505 case 6 1.jpgCorrect
Answer: Extrinsic allergic alveolitis
Histology: none provided
Discussion: In this case all of the classic elements of Extrinsic Allergic Alvolitis are present:
bronchiolitis obliterans organizing pneumonia (BOOP), interstitial chronic inflammation, and poorly formed interstitial granulomas. Interstitial inflammation can be seen in patients with sarcoid, however, BOOP is clearly not a normal characteristic feature of sarcoid and the granulomas seen in sarcoid are much more distinct than those seen in Extrinsic Allergic Alveolitis. Bronchiolitis obliterans organizing pneumonia in this case is seen as “secondary” BOOP. BOOP is a “primary”, when it is the main component of a well-sampled process or lesion in the lung. Secondary BOOP is BOOP seen as a component of some other specifically diagnosable disease such as, in this instance, Extrinsic Allergic Alveolitis. The distinction between primary and secondary BOOP is often extremely difficult in transbronchial biopsies and in general it is unwise to make an unqualified diagnosis of BOOP solely on the basis of a transbronchial biopsy.Incorrect
Answer: Extrinsic allergic alveolitis
Histology: none provided
Discussion: In this case all of the classic elements of Extrinsic Allergic Alvolitis are present:
bronchiolitis obliterans organizing pneumonia (BOOP), interstitial chronic inflammation, and poorly formed interstitial granulomas. Interstitial inflammation can be seen in patients with sarcoid, however, BOOP is clearly not a normal characteristic feature of sarcoid and the granulomas seen in sarcoid are much more distinct than those seen in Extrinsic Allergic Alveolitis. Bronchiolitis obliterans organizing pneumonia in this case is seen as “secondary” BOOP. BOOP is a “primary”, when it is the main component of a well-sampled process or lesion in the lung. Secondary BOOP is BOOP seen as a component of some other specifically diagnosable disease such as, in this instance, Extrinsic Allergic Alveolitis. The distinction between primary and secondary BOOP is often extremely difficult in transbronchial biopsies and in general it is unwise to make an unqualified diagnosis of BOOP solely on the basis of a transbronchial biopsy.
