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99) Such features (used to argue for an alternative diagnosis) include granulomas within alveolar or bronchiolar air spaces, organizing pneumonia, interstitial inflammation in alveolar septa away from the granulomas, extensive necrosis or suppuration, numerous eosinophils, or vegetable material.
100) However, illustrations of chronic beryllium disease in the literature show interstitial inflammation and poorly formed granulomas, the overall picture being more similar to hypersensitivity pneumonitis than sarcoidosis.
The authors described histologically centrilobular and bronchiolocentric fibrosis with patchy interstitial inflammation.
Some degree of interstitial inflammation is usually present, especially in areas of honeycomb change, but the very patchy inflammation is overshadowed by fibrosis as the dominant finding.
Increased interstitial inflammation should prompt suspicion for a superimposed infectious process.

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