CHEST Guidelines-Pulmonary-Nodules-in-an-Adolescent-Female-Presente

Pulmonary-Nodules-in-an-Adolescent-Female-Presente

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A case study describes a 14-year-old girl presenting with right upper quadrant abdominal pain, fatigue, anorexia, dyspnea, and weight loss. Her medical history includes type 1 diabetes, Kawasaki disease, and gastroesophageal reflux. Family history involves colitis and gastroesophageal reflux in her parents. Physical examination showed mild pain in the right upper abdomen without significant respiratory or neurological concerns.<br /><br />Imaging and diagnostic studies identified multiple pulmonary nodules through chest radiographs and CT scans, revealing necrotizing granulomas. Blood tests showed elevated inflammatory markers, but connective tissue diseases were ruled out. Angiotensin-converting enzyme levels were elevated, indicating possible sarcoid pathology, and a wedge biopsy confirmed necrotizing granulomatous processes.<br /><br />The diagnosis was necrotizing sarcoid granulomatosis (NSG), a rare non-infectious pulmonary condition, commonly debated as a sarcoidosis variant. NSG, typically affecting adults over 40, showed a spontaneous resolution in this case, which is rare among children. Pathologically, NSG is characterized by sarcoid-like granulomas with necrosis and vasculitis within the granulomas.<br /><br />The differential diagnosis of pulmonary nodules in children includes infections, malignancies, and inflammatory disorders, with NSG being a rare consideration. While corticosteroid treatment often results in a favorable prognosis and radiographic resolution, this case was managed through observation.<br /><br />This case emphasizes understanding pulmonary nodules' differential diagnosis in adolescents, recognizing NSG as a potential albeit rare cause. Despite ongoing debates about its categorization, knowledge of NSG’s clinical, radiographic, and histopathologic presentations is crucial for diagnosis and management, with consideration of spontaneous resolution in children despite limited literature on treatment necessity.

Keywords

necrotizing sarcoid granulomatosis

pulmonary nodules

adolescents

spontaneous resolution

sarcoidosis variant

granulomas

diagnosis

treatment

children

inflammatory disorders