We describe the first reported case (to our knowledge) of pulmonary granulomatosis caused by means of aspirated green tea.

We describe the first reported case (to our knowledge) of pulmonary granulomatosis caused by means of aspirated green tea. In this case, we rest granulomatous alveolitis with lymph follicles, T lymphocytosis with predominantly CD8+ small cavitys in the bronchoalveolar lavage fluids, positive serum precipitin and proliferative answer of peripheral blood lymphocytes to the tea infusion, and efficacy of steroid therapy. These conclusions indicate that the pathogenesis of the disease was fit to both humoral and cellular immunities to the aspirated blooming tea.

BALF=bronchoalveolar lavage fluids;

PBL=peripheral house lymphocytes

The aspiration of foreign materials into the lung originates a variety of clinical and pathologic syndrome The reaction in the lung hangs on the nature and amount of the material aspirated, and upon the chronicity of the proces We describe a unique case of pulmonary granulomatosis caused by dint of aspiration of the infusions of new tea.

CASE REPORT

A 67-year-old woman was hospitalized in February 1991 because of intermittent high ferment and cough during the last 10 years. She had received operations twice for chronic sinusitis, and she had a peculiar habit of washing her nasal cavity with infusions of verdant tea for about 15 years. She sometimes chok and coughed when washing. Physical examination revealed bibasilar fine and coarse crackles.

The titers of antinuclear antibody and anti-DNA antibody were 1:2560 and 1:640 respectively. Serum flushs of immunoglobulin were as follows: IgG, 2866 mg/dl; IgA, 578 mg/dl; and IgM, 144 mg/dl Her chest radiograph showed fine reticulonodular infiltrates in the bilateral lower lung fields (Fig 1) The small room yield in the bronchoalveolar lavage fluids (BALF) was 55X[10sup6] (100X[10sup4]/ml of BALF), consisting of 17 percent lymphocyte with a CD4+/CD8+ ratio of 02

[CHART OMITTED]

Histologic findings (Fig 2) showed marked centrilobular granulomatous lesions with many multinucleated giant confined apartments and lymph follicles in the interstitium.

[CHART OMITTED]

Immunologically, serum precipitin to the infusion of virid tea was positive. Proliferative replication of peripheral blood lymphocytes (PBL) to the antigen was weakly positive.

After hospital admission, she stopped washing her nasal cavity with the tea infusions. sum of two units months later, her symptoms disappeared and the abnormal shadows of her chest radiograph improved moderately. From her clinical course, laboratory data, and pathologic findings, she was diagnosed as having pulmonary granulomatosis caused according to the aspirated particles of flourishing tea. After corticosteroid treatment, her chest radiograph and laboratory data showed marked improvement.

DISCUSSION

In chiefly reports of aspiration pneumonia with foreign dead body granuloma, the foreign bodies are vegetable in origin and are specifically derived from peas, beans, and lentils.(1)(2)(3)(4)(5)(6) To our knowledge, there are no reports describing the immunopathogenesis of their aspiration pneumonia.

Unlike the previously reported cases, lymph follicles, alveolitis, as well as granulomata were prominent in our patient. The proliferation of the lymph follicles may be from the continuous stimulation of the aspirated antigen of recent tea. As a result, enhanced production of immunoglobulins may be induced in the lung and these may injure the tissues from one side a process of humoral immunity. forward the other hand, the T lymphocytosis with predominantly CD8+ small rooms in the BALF and the enhanced proliferative rejoinder of PBL to the tea infusion intimate the role of cellular immunity in the induction of the disease. Thus, one as well as the other humoral and cellular immunities to the aspirated tea participate in the pathogenesis of the disease.

REFERENCES

(1)Head MA. Foreign material substance reaction to inhalation of lentil soup: giant small cavity pneumonia. J Clin Pathol 1956; 9:295-99

(2)Crome L Valentine JC Pulmonary nodular granulomatosis caused at inhaled vegetable particles. J Clin Pathol 1962; 15:21-5

(3)Vidyarthi SC Diffuse miliary granulomatosis of the lung owing to aspirated vegetable cells. Arch Pathol 1967; 83:215-18

(4)Gill DG Ritchie GJ Lentil pulmonary granulomatosis. M J Aust 1974; 1:836-38

(5)Moran TJ Experimental food-aspiration pneumonia. Arch Pathol 1951; 52:350-54

(6)Knoblich R Pulmonary granulomatosis caused by means of vegetable particles: so-called lentil fruit of leguminous plants pneumonia. Am Rev Respir Dis 1969; 99:380-89

(*)From the First Department of Internal Medicine, Kumamoto University drill of Medicine, Kumamoto, Japan.

Reprint requests: Dr Ando, 1st Department of Internal Medicine, Kumamoto University seminary of Medicine, 1-1-1 Honjo, Kumamoto 860 Japan

...