A MISLEADING DIAGNOSIS OF HYPERSENSITIVITY PNEUMONITIS IN A PATIENT SUFFERING FROM AN ASPERGILLUS INFECTION AND AUTOSOMAL CHRONIC GRANULOMATOUS-DISEASE (CGD) - JUST ONE EXAMPLE OF A DIAGNOSTIC TRAP TYPICAL FORTHIS KIND OF CGD

Chronic granulomatous disease (CGD) is caused by the inability of phag ocytes to kill ingested germs by microbicidal reactive oxygen. Especia lly forms of CGD with retained ability to produce some reactive oxygen sometimes tend to imitate other diseases. An 8-year-old girl with a n ormal history presented with many symptoms matching those of hypersens itivity pneumonitis like restrictive ventilation disorder, suggestive chest x-ray, a majority of CD8 positive lymphocytes in the broncho-alv eolar-lavage fluid (BAL), suggestive histological valuation. Hints for the true underlying disease like neutrophilia and a high anti-Aspergi llus-titer could be overlooked easily. The patient was treated with st eroids and antibiotics because an infection could not be excluded. The CGD had not been recognised at this time, however. After a significan t improvement for a short time the patient experienced a dramatic resp iratory deterioration. A lot of Aspergillus could now be found in the BAL. Finally the patient died because of an ARDS and respiratory insuf ficiency even though signs of the Aspergillus infection improved signi ficantly. Discussion: Whenever CGD must be considered appropriate diag nostics have to be performed-especially before treatment with steroids .