Diffuse panbronchiolitis: a treatable sinobronchial disease in need of recognition in the United States

Diffuse panbronchiolitis (DPB) is a progressive inflammatory disease, well recognized in Japan, characterized by sinusitis and obstructive small airway disease; if left untreated, it progresses to bronchiectasis, respiratory failure, and death. Treatment using low-dose erythromycin has proven to be highly efficacious. Lack of familiarity with DPB in the United States may result in the failure to correctly diagnose and treat this disorder. We describe a Cambodian man in whom the characteristic imaging and histologic features of DPB were elicited but not recognized in spite of evaluation at a referral center. When DPB was diagnosed 6 years later, he was in respiratory failure, but made an excellent recovery once erythromycin therapy was instituted. We report this case to increase physician awareness of DPB as a cause of sinobronchial disease and discuss its diagnostic features so that the disease is recognized and treated without delay.