CRA28 A SPARKLING SURPRISE: THE RETROCARDIAC MASS THAT SPARKLED WITH CHARCOT-LEYDEN CRYSTALS

Daanisha Nayar, Wong Kah Weng, Wan Jen Lye, Noor Izyani Binti Zakaria, Shivaanand A/L Letcheminan
Respiratory Department, Selayang Hospital, Malaysia

Background
Asthma is often associated with eosinophilic inflammation, where eosinophils accumulate in the airways. The breakdown of these eosinophils leads to the formation of Charcot-Leyden crystals indicating the hallmark of eosinophilic inflammation which can be seen in asthma and parasitic infection. We present a case of a retrocardiac mass mimicking malignancy in an asthmatic patient, later diagnosed as infective in origin.

CasePresentation
A 40-year-old female with background allergic bronchial asthma, well-controlled with Symbicort Turbohaler with rhinosinusitis presented with a 3-day history of fever, cough, and left shoulder pain. Physical examination is unremarkable. Blood investigations revealed elevated inflammatory markers, with white blood cell count of 24 × 10⁹/L and C-reactive protein level of 31 mg/L. Eosinophil count on admission was 0.07 (Low) . No evidence of other organ involvement was noted. Contrast-enhanced computed tomography (CT) thorax revealed a 2.3 x 6.2 x 5.8 cm multicystic rim-enhancing mass in the anteromedial segment of the left lower lobe. Bronchoscopy showed narrowing LB8 lumen with purulent secretions. Bronchial washing cultures showed no microbial growth, and all corresponding bronchial washing samples for tuberculosis workup returned negative results. Interestingly, biopsy from left lower lobe revealed mucinous material with eosinophils and extracellular Charcot-Leyden crystals, consistent with asthmatic inflammation with superimposed infection and no malignant cell seen. The patient was treated with six weeks of Amoxycillin-Clavulanic Acid. Repeated CT at 8 weeks showed complete resolution of the mass, and symptoms improved clinically.

Conclusion
This case highlights the histopathological manifestation of Charcot-Leyden Crystal in an asthmatic airway. Aside from that, encountering a mass-like thoracic infective lesion that mimics malignancy is quite intriguing.