From the Research
Pleurisy in a patient with bronchocentric granulomatosis requires prompt treatment with corticosteroids, typically starting with prednisone 40-60mg daily. This condition, characterized by granulomatous inflammation centered on bronchi, often presents with pleuritic chest pain that worsens with breathing. Initial management should include pain control with NSAIDs like ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily. For severe cases, a tapering course of prednisone over 2-3 months is recommended, with gradual dose reduction after clinical improvement, as seen in a case report and literature review of bronchocentric granulomatosis in rheumatoid arthritis 1. Patients should be monitored for symptom resolution and potential steroid side effects. In refractory cases, immunosuppressants such as azathioprine (2mg/kg/day) or mycophenolate mofetil (1-1.5g twice daily) may be added as steroid-sparing agents. The pleurisy in bronchocentric granulomatosis stems from inflammatory processes extending to the pleural surface, and steroids work by suppressing this inflammation. Patients should also receive prophylaxis against opportunistic infections if on prolonged immunosuppression, including Pneumocystis pneumonia prophylaxis with trimethoprim-sulfamethoxazole when appropriate.
Some key points to consider in the management of pleurisy in bronchocentric granulomatosis include:
- The use of corticosteroids as the primary treatment, with the goal of reducing inflammation and preventing further tissue damage 1
- The potential benefits of adding immunosuppressants in refractory cases, although this should be done with caution and close monitoring for side effects
- The importance of prophylaxis against opportunistic infections, particularly in patients on prolonged immunosuppression
- The need for careful monitoring of patients for symptom resolution and potential side effects of treatment, as well as regular follow-up to adjust the treatment plan as needed.
It's worth noting that while other studies have investigated the use of corticosteroids in different contexts, such as tuberculous pleurisy 2 or community-acquired pneumonia 3, the most relevant and recent evidence for the management of pleurisy in bronchocentric granulomatosis is the case report and literature review from 2020 1. This study provides valuable insights into the clinical and imaging features of bronchocentric granulomatosis in rheumatoid arthritis patients, and highlights the importance of prompt treatment with corticosteroids to achieve complete remission of symptoms and radiological stability.