Published online Jan 16, 2024. doi: 10.12998/wjcc.v12.i2.354
Peer-review started: September 19, 2023
First decision: November 22, 2023
Revised: December 6, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: January 16, 2024
There are few cases of pulmonary granulomatous changes secondary to primary biliary cirrhosis (PBC). No case of granulomatous lung disease secondary to PBC misdiagnosed as lung cancer had been reported.
A middle-aged woman presented with lung nodules and was misdiagnosed with lung cancer by positron emission tomography/computed tomography. She underwent left lobectomy, and the pathology of the nodules showed granulomatous inflammation, which was then treated with antibiotics. However, a new nodule appeared. Further investigation with lung biopsy and liver serology led to the diagnosis of PBC, and chest computed tomography indicated significant reduction in the pulmonary nodule by treatment with methylprednisolone and ursodeoxycholic acid.
Diagnosis of pulmonary nodules requires integrating various clinical data to avoid unnecessary pulmonary lobectomy.
Core Tip: Primary biliary cholangitis (PBC) can present as granulomatous lung disease when the lungs are involved. A patient with pulmonary granulomatous disease secondary to PBC was misdiagnosed with lung cancer by positron emission tomography/computed tomography (PET/CT), leading to unnecessary lobectomy. The symptoms and imaging of pulmonary granulomatous disease secondary to PBC are nonspecific. It also appears as high fluorodeoxyglucose uptake on PET/CT scan. Diagnosis should not rely solely on PET/CT findings but should consider clinical data, lung aspiration biopsy, and immune-related disease indexes to avoid unnecessary physical and financial burden.