SESSION TITLE: Obstructive Airway Disease Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 26, 2014 at 03:15 PM - 04:15 PM
INTRODUCTION: Constrictive bronchiolitis is characterized by bronchiole lumen narrowing and fibrosis, and has been associated with inhalation injury. This otherwise rare disease has been increasingly described among soldiers deployed to the Middle East, and is thought to relate to inhalational exposures from burn pits. We present such a case to highlight the difficulty of diagnosis and increase awareness of this condition.
CASE PRESENTATION: A thirty seven year old male presented with symptoms of dyspnea that had progressively worsened over the prior three years. He had noted a decline in his ability to run a mile which previously he was able to do in less than seven minutes to now taking fifteen minutes. He was deployed to Iraq six years ago and did admit to being near burn pits but denied any known specific inhalational exposures. He denied any sputum production or cough. He had been seen by an allergy specialist who suspected that his symptoms related to asthma and placed him on an inhaled corticosteroid and rescue inhaler. Skin testing did reveal sensitivity to dust mite and grass pollen, he was also placed on cetirizine. He continued to have ongoing dyspnea despite adherence to these treatments and was referred to our pulmonary clinic for further evaluation. Chest imaging only showed focal bronchiectasis within the right lower and middle lobe. Pulmonary function testing demonstrated restriction with a total lung capacity of 74% predicted and no obstruction. Out of concern for an atypical infection a bronchoscopy with bronchoalveolar lavage was performed. Cultures only revealed methicillin sensitive staphylococcus aureus, which he received a two week course of antibiotics for without any improvement in symptoms. Due to his military exposure history and otherwise unremarkable workup, an open lung biopsy was performed demonstrating constrictive bronchiolitis.
DISCUSSION: Constrictive bronchiolitis can be a challenging diagnosis to make as imaging and pulmonary function studies may be normal with the only presenting symptoms being mild dyspnea or a gradual decline in activity level. Corticosteroids may provide some benefit but no specific therapy presently exists.
CONCLUSIONS: In soldiers returning from military deployment with symptoms of dyspnea without a clear explanation, consider the diagnosis of constrictive bronchiolitis.
Reference #1: King, M et al. Constrictive Bronchiolitis in Soldiers Returning from Iraq and Afghanistan. N Engl J Med 2011;365;222-30.
DISCLOSURE: The following authors have nothing to disclose: Umar Osman, Rebecca Bascom
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