Diffuse panbronchiolitis (DPB) is a bronchiolitis affecting the whole lung fields which can be treated by macrolide. Especially East Asian patients are more susceptible to diffuse panbronchiolitis. As asthma and DPB both can cause airway obstruction, differential diagnosis is important for the 2 diseases. Here we report 5 patients with DPB clinically presenting as severe asthma in Korea, who were well treated by macrolide. Among the 5 patients, 2 could stop their asthma inhalers and the other 3 could reduce asthma medications after diagnosis and treatment of DPB. In conclusion, considering DPB as differential diagnosis for asthmatics in Asian ethnic groups is important.
Adult ; Aged ; Anti-Asthmatic Agents/*therapeutic use ; Asthma/*diagnosis/*drug therapy ; Bronchiolitis/*diagnosis/*drug therapy ; Diagnosis, Differential ; Female ; Haemophilus Infections/*diagnosis/*drug therapy ; Humans ; Macrolides/*administration & dosage ; Male ; Middle Aged ; Severity of Illness Index ; Treatment Outcome

OBJECTIVETo study the clinical features of bronchiolitis obliterans (BO) in children.

METHODSThe clinical data of 28 children with BO between July 2007 and April 2012 was retrospectively reviewed.

RESULTSAll patients presented with persistent or repeated cough and wheezing. Twenty-three cases were post-infectious bronchiolitis obliterans (PIBO), among whom the etiology were adenovirus (12 cases), measles (2 cases), influenza virus A (2 cases), mycoplasma pneumoniae (1 case), mycoplasma pneumoniae coinfection with adenovirus (1 case), respiratory syncytial virus coinfection with Parainfluenza type 3 virus (1 case) and pulmonary tuberculosis (1 case). The etiology of 3 cases was not associated with infection. The etiology was unknown in 2 cases. Pulmonary HRCT revealed that decreased density in 25 cases, mosaic perfusion in 21 cases, bronchial wall thickening in 15 cases, bronchiectasis in 12 cases and air retention in 6 cases. Lung function test was performed on 21 cases and demonstrated that obstructive ventilation disorder in all 21 cases. Bronchodilation test was performed on 18 cases and 17 cases showed a negative result. All 28 cases received corticosteroid treatment, and 24 cases were orally administered with low doses of azithromycin. One case died during hospitalization. Eighteen cases were followed up for 4 months to 4 years and seven months. Clinical manifestations were improved in 12 cases and one case died.

CONCLUSIONSLow respiratory infection is the most common cause of pediatric BO and adenovirus is a major pathogen. Persistent wheezing and cough were main clinical manifestations. Pulmonary HRCT imaging is important for diagnosis and follow-up of BO. Lung function test can typically show obstructive ventilation disorder. Corticosteroid and methotrexate may be effective for treatment of BO. Prognosis of this disease is unsatisfactory. Early diagnosis and treatment, and avoidance of repeated respiratory tract infection may be helpful to improve the prognosis.

Bronchiolitis Obliterans ; diagnosis ; drug therapy ; etiology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Prognosis ; Respiratory Function Tests ; Retrospective Studies ; Tomography, X-Ray Computed

A case of dermatomyositis presented as bronchiolitis obliterans organizing pneumonia has been rarely reported. We describe a 46-year-old female patient with dermatomyositis without elevation of creatine kinase presented as bronchiolitis obliterans organizing pneumonia. She was treated with prednisolone and azathioprine. Over a 2-year follow-up she has had no elevation of creatine kinase. The patient remains asymptomatic and has no medication for dermatomyositis and bronchiolitis obliterans organizing pneumonia two years after initial treatment. It has been suggested that the prognosis of dermatomyositis without creatine kinase elevation may be poor. Because the prognosis of bronchiolitis obliterans organizing pneumonia is generally believed to be good, we tentatively suggest that the normal value of creatine kinase in dermatomyositis does not always seem to herald a poor prognosis, an associated malignancy or severe interstitial lung disease.
Azathioprine/administration +ACY- dosage ; Biopsy, Needle ; Bronchiolitis Obliterans Organizing Pneumonia/pathology ; Bronchiolitis Obliterans Organizing Pneumonia/diagnosis+ACo- ; Case Report ; Creatine Kinase/blood+ACo- ; Dermatomyositis/pathology ; Dermatomyositis/enzymology ; Dermatomyositis/drug therapy ; Dermatomyositis/diagnosis+ACo- ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Human ; Middle Age ; Prednisone/administration +ACY- dosage ; Tomography, X-Ray Computed

We describe a patient with rheumatoid arthritis(RA) who developed bronchiolitis obliterans organizing pneumonia(BOOP) during the treatment of bucillamine. A 51 year-old man was admitted to the hospital for an abnormal shadow on his chest radiogragh. He had been diagnosed as having RA 3 years previously and had been receiving 200 mg of bucillamine for 21 months. Two months prior to admission, he presented with a cough and his chest X-ray showed opacities in both lower lungs. He was treated with antibiotics for 2 months after the development of cough and lesions on the chest X-ray, but the symptoms and lung lesions became more aggravated. On admission, an HRCT revealed airspace consolidations in the subpleural space of both basal lungs and a CT-guided fine needle aspiration biopsy showed Masson's body filling air space, interstitial infiltration of acute and chronic inflammatory cells and type II cell hyperplasia, consistent with BOOP. Bucillamine was stopped and 50 mg of prednisolone was administered. His symptoms and infiltrations on the chest X-ray resolved. We suggest that bucillamine should be considered as a drug possibly associated with BOOP.
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects* ; Arthritis, Rheumatoid/drug therapy* ; Biopsy, Needle ; Bronchiolitis Obliterans Organizing Pneumonia/diagnosis* ; Bronchiolitis Obliterans Organizing Pneumonia/chemically induced* ; Case Report ; Cysteine/therapeutic use ; Cysteine/analogs & derivatives ; Cysteine/adverse effects* ; Follow-Up Studies ; Human ; Male ; Middle Age ; Radiography, Thoracic ; Risk Assessment ; Tomography, X-Ray Computed