Saf Health Work.  2021 Jun;12(2):268-271. 10.1016/j.shaw.2021.03.001.

A Lung Granuloma Case Possibly Associated with a Working Environment: A Case Report

• Seehapanya S
• Chaiear N
• Ratanawatkul P
• Samerpitak K
• Intarawichian P
• Wonglakorn L

• KMID: 2518545
• DOI: http://doi.org/10.1016/j.shaw.2021.03.001

Abstract

Lung granulomas are uncommon in Thailand. The disease typically develops from an occupational environment and is mostly caused by infection. Herein is a case report of a female patient, aged 48, working as a nurse in an Accident and Emergency Department at a hospital. Eighteen years prior to admission the patient was diagnosed with myasthenia gravis and pulmonary tuberculosis. The chest X-ray and CT scans showed a solitary pulmonary nodule in the lower left lung. The patient received an open thoracotomy with a left lobectomy. Granulomatous and nonseptate hyphae were found in the pathology diagnosis. The patient was thus diagnosed as having a lung granuloma. The galactomannan antigen test was positive. The solitary pulmonary nodule—found from the use of a Polymerase Chain Reaction (PCR) test—was an Aspergillus spp. The fungus culture was collected from air samples. The air samples were collected by the impaction technique using a microbial air sampler. Three types of Aspergillus spp. were found as well as Penicillium spp. and Monilia sitophila. The Aspergillus spp. was a match for the patient's disease. The patient was diagnosed as having a lung granuloma possibly Aspergillus nodule which was caused by airborne Aspergillus spp. from the occupational environment.

Keyword

aspergillus; lung granuloma; occupational lung; working environment