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(Chest. 2000;117:1511-1515.)
© 2000 American College of Chest Physicians

Necrotizing Pulmonary Granulomata in a Marijuana Smoker*

David Cunnington, MB, BS; Harry Teichtahl, MB, BS(Hons), FCCP; John M. Hunt, MB, BS; Chris Dow, MB, BS and Renata Valentine, MB, BS

* From the Departments of Respiratory Medicine (Drs. Cunnington, Teichtahl, and Hunt) and Pathology (Drs. Dow and Valentine), Western Hospital, Melbourne, Australia.

Correspondence to: David Cunnington, MB,BS, Department of Respiratory Medicine, Western Hospital, Gordon St, Footscray 3011, Australia; e-mail: david.cunnington{at}nwhcn.org.au

We describe the case of a heavy marijuana and tobacco smoker who presented with progressive exertional dyspnea of 2 months’ duration, and bilateral nodular lung infiltrates. Examination of the lung fields was normal, and lung function tests showed mild airflow obstruction with moderately reduced gas transfer. BAL returned green-black fluid consisting predominantly of macrophages laden with carbon pigment. Thoracoscopic lung biopsy showed miliary necrotizing granulomata with an alveolar exudate of carbon-laden macrophages within macroscopically blackened lung. The differential diagnosis of pulmonary granulomata in this patient is discussed.

Key Words: granuloma • marijuana • pulmonary • tobacco




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