Objective To summarize the clinical features, diagnosis and treatment of postinfection bronchiolitis obliterans. Methods Clinical manifestation, chest X-ray, characteristics of lung function,computed tomography ( CT) of 6 patients with postinfection bronchiolitis obliterans from August 2009 to June2012 were analyzed retrospectively.Results All 6 cases were diagnosed as bronchiolitis obliterans after pneumonia. One patient had severe pneumonia complicated with congenital atrial septal defect and heart failure. 3 cases were complicated with varying degrees of cardiac insufficiency. Adenovirus in sputumsample were found in2 cases, smear positive for parainfluenza virus was found in1 case, mycoplasma were found in 2 cases, and no specific pathogen was found in the last one. All 6 cases were suffered frompersistent cough,wheezing and shortness of breath with three depression sign in 4 cases. The symptoms lasted for at least 6 weeks. Crackles and wheezing were present in all 6 cases. Small airway lesion was presented by pulmonary CT. Bronchiectasis was showed in 2 cases, atelectasis in 1 case, and consolidation in 1 case. Pulmonary function tests showed mixed ventilatory dysfunction. Bronchofiberscope examination was operated in5 cases,only endotracheitis was found. Prednisone and azithromycin were given orally in all the cases, but the clinical symptoms were persistent in the course of treatment and no death occured. Conclusions Clinical symptoms of bronchiolitis obliterans are characterized by persistent cough and wheezing. Small airway lesions were present in pulmonary CT. Repeated lower respiratory infection is common. Prednisone is widely used in treatment of bronchiolitis obliterans, but the therapeutic effect is uncertain.
Objective To explore the clinical characteristics, diagnose and treatment of bronchiolitis obliterans (BO) associated with lymphoma and paraneoplastic pemphigus (PNP). Methods One patient with BO associated with lymphoma and paraneoplastic pemphigus was presented and literatures which searched through Wanfang Med online and PubMed on this subject were reviewed. Results A 44-year-old woman was admitted to this hospital because of oral ulcer for two years, and persistent dyspnea for fourteen months. She had been diagnosed with PNP one year earlier. Pulmonary function displayed severe obstructive ventilator dysfunction, negative response to the bronchodilator. Chest CT showed bronchiolectasis. The ratio of neutrophils increased in bronchoalveolar lavage fluid. The pathology of ultrasound-guided neck and inguinal lymph node biopsy showed non-Hodgkin’s lymphoma. Based on the clinical presentation, the image and pathology of this patient, the diagnosis of having PNP with BO secondary to the lymphoma was made. After 10 cycles of CHOP chemotherapy, lymphoma and PNP went into remission, but the patient died from respiratory failure. The literatures were reviewed and 15 patients were found, out of them 60% (9/15) were female, 47% (7/15) follicular lymphoma and 47% (7/15) diagnosis of clinical BO which did not be supported by pathology. Lymphoma-PNP-BO was a clinical syndrome and 67% of the initial presentations were PNP. Patients died within 7 to 60 months. Conclusions BO associated with lymphoma and PNP is rare and the most common initial presentation is PNP. BO is the major cause of death. Treatments included chemotherapy, corticosteroid and immunosuppressor, lymphoma and PNP can be alleviated, but BO is aggravating.
Objective To investigate the etiology and the clinical features of obliterative bronchiolitis (OB). Methods Sixteen admitted patients were diagnosed as OB in Peking Union Medical College Hospital from Jan 1990 to May 2018. The case records were reviewed retrospectively. Results Twelve patients were female and 4 patients were male. The median age was 33.5 years (ranged from 17 to 55). The common symptoms included: exertional dyspnea in 15 patients (94%), cough in 10 patients (63%), phlegm production in 8 patients (50%). All of the 16 patients had associated conditions: paraneoplastic pemphigus in 6 patients (Castleman’s disease, lymphoproliferative disorder, inflammatory myofibroblastic tumor and follicular dendritic cell tumor respectively), chronic graft-versus-host disease after hematopoietic stem-cell transplantation in 3 patients, thymoma in 2 patients, Behcet’s disease, Sjögren syndrome, multiple myeloma, myasthenia gravis, and oral lichen planus in 1 patient respectively. The pulmonary function tests revealed severe or very severe obstructive ventilatory defect in all 16 patients. The CT scans showed slight ground-glass opacities in 10 patients, decreased attenuation of lung in 9 patients, mosaic attenuation in 8 patients, bronchiectasis in 7 patients, and air trapping in 3 patients. Conclusions OB is a clinical syndrome characterized by progressive airway obstruction, resulting from a variety of exposures or diseases. In most cases, diagnosis can be obtained on the basis of typical clinical, physiological, and radiological features, combined with OB-related diseases or exposures. Surgical lung biopsy can help diagnosis but risk-benefit should be taken into consideration seriously.