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Diffuse panbronchiolitis in children misdiagnosed as asthma: A case report
Anuvat Klubdaeng1, Prakarn Tovichien2
1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Insights
Diffuse panbronchiolitis (DPB) in a child, initially misdiagnosed as asthma, resolved with azithromycin. Early diagnosis and treatment are crucial for favorable outcomes in this rare inflammatory lung disease.
Area of Science:
- Pulmonology
- Pediatric Respiratory Medicine
- Clinical Case Study
Background:
- Diffuse panbronchiolitis (DPB) is a rare chronic inflammatory lung disease often misdiagnosed as asthma, especially in children.
- DPB presents with chronic cough, breathlessness, and sinusitis, persisting for years.
Observation:
- A 12-year-old girl with a history of asthma presented with persistent cough and sinusitis unresponsive to asthma treatment.
- High-resolution computed tomography (HRCT) revealed characteristic findings of DPB, including centrilobular nodules and a 'tree-in-bud' pattern.
Findings:
- Long-term azithromycin therapy led to rapid resolution of cough and sinusitis within a month.
- One-year follow-up HRCT scans demonstrated complete normalization of lung abnormalities, confirming treatment efficacy.
Implications:
- This case underscores the importance of considering DPB in pediatric patients with refractory respiratory symptoms.
- Timely and accurate diagnosis, followed by appropriate treatment such as azithromycin, can lead to favorable outcomes and disease resolution in DPB.
Background:
Diffuse panbronchiolitis (DPB) is a rare, chronic inflammatory lung disease marked by chronic cough, breathlessness, and preceding sinusitis. Symptoms often persist for years and can be misdiagnosed as asthma, particularly in children. This report describes a DPB case resolved with long-term azithromycin therapy, emphasizing the need for a timely and accurate diagnosis.
Case Summary:
A 12-year-old girl, diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists, developed a history of chronic productive cough and chronic sinusitis for a year. On examination, she exhibited wheezing and coarse crackles. Despite receiving treatment for an asthma exacerbation, her symptoms did not improve. A chest X-ray revealed reticulonodular infiltration in both lower lungs, prompting further evaluation with high-resolution computed tomography (HRCT). The HRCT confirmed centrilobular nodule opacities, a 'tree-in-bud' pattern, and non-tapering bronchi, suggesting DPB. Elevated cold hemagglutinin titers at 128 further supported the diagnosis. Her cough and sinusitis resolved within a month after starting azithromycin therapy, chosen for its anti-inflammatory and immunomodulatory effects. Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.
Conclusion:
This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
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