Diffuse panbronchiolitis: A case report from a Chinese consanguineous marriage family and literature review

Squawks as an important physical finding for differentiation of diffuse panbronchiolitis from asthma in children: A case report

Diffuse panbronchiolitis (DPB) is an idiopathic chronic inflammatory pulmonary disease clinically characterized by cough, sputum, and chronic sinusitis. Although the average age of onset is 40 years, DPB occasionally occurs in children and is often misdiagnosed as asthma. Long-term therapy with macrolide antibiotics significantly improves survival in DPB. Herein, we report the case of a 16-year-old man who had been treated for asthma and was referred to our department as transition from the Department of Pediatrics. Adequate auscultation to detect squawks and history taking of purulent sputum led to the correct diagnosis and appropriate treatment, which improved his quality of life.

Clinical characteristics of 32 cases of diffuse panbronchiolitis

OBJECTIVES

Diffuse panbronchiolitis (DPB) is a chronic airway inflammation with low specificity and its diagnosis is often missed or delayed. This study aims to summarize the clinical characteristics and treatment of DPB in order to improve the understanding and diagnosis of the disease.

METHODS

The clinical data of 32 DPB patients were collected, analyzed and summarized from March 1, 2013 to March 1, 2022 in the Second Xiangya Hospital of Central South University. The basic information, clinical manifestations, laboratory tests, pulmonary function, imaging tests, treatment, and regression of patients were analyzed.

RESULTS

A total of 32 patients were enrolled in the final analysis, with a male-to-female ratio at 1.67. The median age at symptom onset was 26.5 (11.0-69.0) years, and the median age of diagnosis was 47.5 (16.0-77.0) years. All patients presented with chronic cough and copious sputum production. A total of 26 patients had post activity shortness of breath and 14 patients had a positive result (blood cold agglutination test titer≥1꞉64). Pulmonary function examination was performed in 31 patients, 18 patients showed mixed pulmonary ventilation dysfunction, 12 patients showed obstructive pulmonary ventilation, and 1 patient had normal pulmonary ventilation function. A total of 31 patients had a bilateral, diffuse, small nodule pattern on chest CT. All patients were treated with macrolides. A total of 31 patients showed improvement, and 20 patients showed improvement in partial pressure of oxygen and blood oxygen saturation compared with before at discharge. A total of 12 patients were re-examined by chest CT after completing macrolides treatment, 6 cases showed less diffuse nodules, 5 cases showed no significant changes, and 1 case showed more diffuse nodules, which indicated the disease progression. Seven patients received pulmonary function tests after completing macrolides treatment, forced expiratory volume in one second (FEV1) and FEV1/forced vital capacitywere improved, but forced expiratory flow at 25% of vital capacity did not change significantly.

CONCLUSIONS

The clinical manifestations of DPB are nonspecific. Early diagnosis and treatment are very important for the prognosis of patients.

Good's syndrome with diffuse panbronchiolitis as the prominent manifestation: A case and literature review

Good's syndrome (GS) is characterized by thymoma combined with adult-onset immunodeficiency. Diffuse panbronchiolitis (DPB) is a chronic inflammatory airway disease, which predominantly affects East Asians. Japanese scholars have reported extensively about GS combined with DPB or DPB-like pulmonary manifestation. However, such reports are rare in China. We report here a case of GS in China with DPB as the prominent manifestation and carry out a literature review accordingly. Our review indicates that in adults with DPB-like clinical manifestations, thymic lesions should be excluded and related immune function tests should be performed to exclude GS to avoid missed diagnosis and misdiagnosis.