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[Clinical analysis of 6 cases of diffuse panbronchiolitis in children]
Li-Xin Deng1, De-Hui Chen, Yu-Neng Lin
1Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Insights
Diffuse panbronchiolitis (DPB) in children presents non-specifically, often leading to misdiagnosis. Consider special infections if low-dose azithromycin treatment for suspected DPB is ineffective.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Radiology
Context:
- Diffuse panbronchiolitis (DPB) is a rare chronic airway inflammatory disease.
- Clinical characteristics and diagnostic challenges in pediatric DPB remain underexplored.
- This study focuses on a small cohort of pediatric DPB cases.
Purpose:
- To analyze the clinical features of pediatric diffuse panbronchiolitis (DPB).
- To improve the diagnosis and treatment strategies for DPB in children.
- To identify potential diagnostic pitfalls and alternative etiologies.
Summary:
- Retrospective analysis of 6 pediatric DPB cases (age 7-12) revealed common symptoms: cough, sputum, dyspnea, and sinusitis history.
- High-resolution chest CT showed diffuse centrilobular nodules with a tree-in-bud pattern.
- Low-dose azithromycin was partially effective; non-tuberculous mycobacteria were identified in some patients, suggesting the need to consider special infections.
Impact:
- Highlights the non-specific clinical presentation of pediatric DPB, increasing misdiagnosis risk.
- Suggests considering special infections, particularly non-tuberculous mycobacteria, in refractory cases.
- Emphasizes the importance of advanced imaging (HRCT) and microbiological investigations for accurate diagnosis and management.
Objectives:
To analyze the clinical characteristics of diffuse panbronchiolitis (DPB) in children and to enhance the clinical diagnosis and treatment of this disease.
Methods:
A retrospective analysis was conducted on the clinical data of 6 children diagnosed with DPB who were hospitalized at The First Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2019.
Results:
Among the 6 patients, there were 2 males and 4 females; the age at diagnosis ranged from 7 to 12 years. All patients presented with cough, sputum production, and exertional dyspnea, and all had a history of sinusitis. Two cases showed positive serum cold agglutinin tests, and 5 cases exhibited pathological changes consistent with chronic bronchiolitis. High-resolution chest CT in all patients revealed centrilobular nodules diffusely distributed throughout both lungs with a tree-in-bud appearance. Five patients received low-dose azithromycin maintenance therapy, but 3 showed inadequate treatment response. After empirical anti-tuberculosis treatment, non-tuberculous Mycobacteria were found in the bronchoalveolar lavage fluid. Follow-up over 2 years showed 1 case cured, 3 cases significantly improved, and 2 cases partially improved.
Conclusions:
The clinical presentation of DPB is non-specific and can easily lead to misdiagnosis. In cases where DPB is clinically diagnosed but does not show improvement with low-dose azithromycin treatment, special infections should be considered.
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