Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0588, USA.
Ann Diagn Pathol. 2010 Dec;14(6):443-6. doi: 10.1016/j.anndiagpath.2009.11.001. Epub 2010 Feb 4.
Diffuse panbronchiolitis (DPB) is an idiopathic inflammatory process involving respiratory bronchioles, largely restricted to Japanese people and associated with HLA Bw54. We report a case of idiopathic bronchiolitis with DPB features in an African American with hepatitis C virus infection, correlated with postmortem anatomic findings. The 53-year-old patient presented with shortness of breath and productive cough. Examination revealed hypercapnic respiratory failure. Lung computed tomography showed diffuse centrilobular nodules and branching linear opacities, whereas lung biopsy demonstrated diffuse peribronchiolar fibrosis and chronic inflammation with bronchiolectasis. He died 37 days postadmission. Autopsy revealed numerous bronchiolocentric nodules with bronchiolectasis and sheets of foamy macrophages in alveolar septa and spaces. This is a rare example of idiopathic bronchiolitis with features of DPB in an hepatitis C virus-infected African-American patient. Hepatitis C virus infection is known to be associated with extrahepatic pulmonary manifestations, and DPB may be one of these. Early diagnosis will allow appropriate treatment and may slow the disease progression.
弥漫性泛细支气管炎（DPB）是一种特发性炎症过程，累及呼吸性细支气管，主要局限于日本人，与 HLA Bw54 相关。我们报告了一例特发性细支气管炎伴有 DPB 特征的病例，患者为一名感染丙型肝炎病毒的非裔美国人，与死后解剖发现相关。这名 53 岁的患者因呼吸急促和咳痰而就诊。检查发现高碳酸血症性呼吸衰竭。肺部计算机断层扫描显示弥漫性中心性结节和分支线性混浊，而肺活检显示弥漫性细支气管周围纤维化和伴有支气管扩张的慢性炎症。他在入院后 37 天死亡。尸检显示许多细支气管中心性结节伴支气管扩张，肺泡间隔和空间中有泡沫状巨噬细胞层。这是非裔美国丙型肝炎病毒感染者特发性细支气管炎伴 DPB 特征的罕见病例。丙型肝炎病毒感染已知与肝外肺部表现有关，DPB 可能是其中之一。早期诊断将允许进行适当的治疗，并可能减缓疾病进展。
