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Chronic bronchiolitis in ankylosing spondylitis.

D Marquette1, E Diot, A de Muret

  • 1CHRU Tours, Hôpital Bretonneau, Service de Pneumologie et Explorations Fonctionnelles Respiratoires; Inserm U 1100, Faculté de Médecine, Université François Rabelais, Tours, France. s.marchandadam@univ-tours.fr.

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Summary

Severe chronic bronchiolitis is a newly described complication in ankylosing spondylitis (AS). This condition presents with progressive dyspnea and obstructive lung defects, with macrolide treatment showing promise for follicular bronchiolitis.

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Area of Science:

  • Pulmonology
  • Rheumatology
  • Pathology

Background:

  • Ankylosing spondylitis (AS) commonly presents with pleuro-pulmonary manifestations, primarily asymptomatic apical lung fibrosis.
  • Severe bronchiolitis, a known complication in other spondyloarthropathies, has not been previously documented in AS patients.

Purpose of the Study:

  • To report and characterize severe chronic bronchiolitis in two patients with ankylosing spondylitis.
  • To investigate the clinical, radiological, and pathological features of this rare complication.

Main Methods:

  • Case report of two ankylosing spondylitis patients with severe respiratory symptoms.
  • Clinical evaluation including pulmonary function tests and high-resolution computed tomography (HRCT) scans.
  • Histopathological examination of lung biopsies.

Main Results:

  • Both patients exhibited progressive dyspnea (stage III-IV) and non-reversible obstructive ventilatory defects.
  • CT scans revealed air trapping with mosaic attenuation and ground-glass opacities during expiration.
  • Lung biopsy confirmed severe follicular bronchiolitis in one patient; constrictive bronchiolitis was suspected in the other.
  • Only the patient with follicular bronchiolitis showed improvement with low-dose macrolide therapy.

Conclusions:

  • Severe chronic bronchiolitis represents a potentially underrecognized pulmonary complication of ankylosing spondylitis.
  • Follicular bronchiolitis may be a treatable subtype, responding to macrolides.
  • Further research is needed to elucidate the pathogenesis and optimal management of bronchiolitis in AS.