Advertisement

A 55-Year-Old Woman With Frequent Pulmonary Exacerbations and Endobronchial Lesions

      Case Presentation

      A 55-year-old woman with COPD, heart failure with preserved ejection fraction (congestive heart failure), diabetes mellitus, and hypertension presented with baseline dyspnea at rest that had worsened over the last week. She reported associated runny nose, congestion, and cough productive of green sputum. She smoked six cigarettes per day and denied alcohol, drugs, or occupational exposure. She was admitted and initiated on treatment for acute exacerbation of COPD; however, her condition did not improve with steroid, ceftriaxone, and nebulized albuterol and budesonide treatments. She had been diagnosed with asthma and COPD without ever undergoing pulmonary function testing. She presented 11 times to the ED with six hospital admissions in the last 1.5 years for worsening dyspnea at rest, wheezing, and lower extremity edema deemed secondary to exacerbation of her COPD or congestive heart failure. She reported medication compliance, which included fluticasone-vilanterol, tiotropium bromide, and furosemide. She repeatedly demonstrated mild vascular congestion on imaging without hyperinflation, a normal to mildly elevated brain natriuretic peptide (<10 to 200 pg/mL), and dyspnea without hypoxia. She was treated normally for both COPD and congestive heart failure exacerbations simultaneously with methylprednisolone, albuterol, and furosemide with rapid improvement over the course of 1 to 2 days. No significant improvement was noted with steroid therapy, despite receiving them as an inpatient and outpatient. At the time of discharge, her symptoms would be at her baseline.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Suggested Readings

        • Abrikossoff A.L.
        [Uber Myome ausgehend von der quergestreifter willkurlichen Musculature.].
        Virchows Arch A Pathol Anat. 1926; 260: 215-233
        • Garancis J.C.
        • Komorowski R.A.
        • Kumzma J.F.
        Granular cell myoblastoma.
        Cancer. 1970; 25: 542-550
        • Deavers M.
        • Guinee D.
        • Koss M.N.
        • Travis W.D.
        Granular cell tumors of the lung: clinicopathologic study of 20 cases.
        Am J Surg Pathol. 1995; 19: 627-635
        • Fanburg-Smith J.C.
        • Meis-Kindblom J.M.
        • Fante R.
        • Kindblom L.G.
        Malignant granular cell tumor of soft tissue: diagnostic criteria and clinicopathologic correlation.
        Am J Surg Pathol. 1998; 22: 779-794
        • Al-Ghamdi A.M.
        • Flint J.D.
        • Muller N.L.
        • Stewart K.C.
        Hilar pulmonary granular cell tumor: a case report and review of the literature.
        Ann Diagn Pathol. 2000; 4: 245-251
        • Van der Maten J.
        • Blaauwgeers J.L.
        • Sutedja T.G.
        • Kwa H.B.
        • Postmus P.E.
        • Wagenaar S.J.
        Granular cell tumors of the tracheobronchial tree.
        J Thorac Cardiovasc Surg. 2003; 126: 740-743
        • Venur V.A.
        • Zhang G.
        • Farver C.
        • Mukhopadhyay S.
        • Raymond D.P.
        • Velcheti V.
        Coexistent pulmonary granular cell tumor and adenocarcinoma of the lung.
        Transl Lung Cancer Res. 2014; 3: 262-264
        • Radić P.
        • Brčić L.
        Pulmonary granular cell tumours: case presentations and literature review.
        Scott Med J. 2017; 62: 70-73
        • Finer E.B.
        • Villalba J.A.
        • Pitman M.B.
        Granular cell tumor of the lung.
        Diagn Cytopathol. 2019; 47: 345-346
        • Davis R.
        • Deak K.
        • Glass C.H.
        Pulmonary granular cell tumors: a study of 4 cases including a malignant phenotype.
        Am J Surg Pathol. 2019; 43: 1397-1402