Klubdaeng Anuvat, Tovichien Prakarn
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
World J Clin Cases. 2025 May 16;13(14):103501. doi: 10.12998/wjcc.v13.i14.103501.
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.
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.
This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
弥漫性泛细支气管炎（DPB）是一种罕见的慢性炎症性肺部疾病，以慢性咳嗽、呼吸困难和先前的鼻窦炎为特征。症状通常持续数年，尤其在儿童中可能被误诊为哮喘。本报告描述了一例通过长期阿奇霉素治疗得以缓解的DPB病例，强调了及时准确诊断的必要性。
一名12岁女孩，5岁时被诊断为哮喘，接受吸入性糖皮质激素和长效β-2受体激动剂治疗，出现慢性咳痰咳嗽和慢性鼻窦炎病史一年。检查时，她表现出喘息和粗湿啰音。尽管接受了哮喘急性加重的治疗，但其症状并未改善。胸部X线显示双下肺网状结节状浸润，促使进一步行高分辨率计算机断层扫描（HRCT）评估。HRCT证实为小叶中心结节状混浊、“树芽征”和非逐渐变细的支气管，提示DPB。冷凝集素滴度升高至128进一步支持诊断。因其具有抗炎和免疫调节作用，选用阿奇霉素治疗，开始治疗后一个月内她的咳嗽和鼻窦炎症状得到缓解。持续治疗1年后的随访HRCT扫描显示完全恢复正常。
本病例强调了早期诊断和及时治疗对DPB取得良好预后的重要性。
