Granulomatous-lymphocytic interstitial lung disease (GLILD) in the absence of common variable immunodeficiency (CVILD)

Granulomatous-lymphocytic interstitial lung disease (GLILD) represents a rare pulmonary disorder most commonly associated with common variable immunodeficiency (CVID). We report a case of GLILD in a 65-year-old man who did not meet criteria for CVID after comprehensive genetic and immunologic testing. The process leading to his diagnosis involved initial detection of incidental FDG-avid pulmonary nodules on PET-CT that demonstrated a waxing and waning pattern on subsequent imaging; histopathology was confirmed with lung biopsy. Multidisciplinary evaluation, tissue diagnosis, and exclusion of infectious or malignant mimics are important for diagnosis. Recognizing this entity is critical for timely treatment and avoidance of unnecessary antimicrobial or oncologic therapy, emphasizing the need for increased awareness amongst thoracic imagers and pulmonary specialists.