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Poster Walks: Poster Walk 1: Airway disease I |

P132 Recurrent pulmonary infections in a patient with tracheobronchopathia osteochondroplastica

J.R. Go; B.A. Soll
Author and Funding Information

Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, United States


Copyright 2017, American College of Chest Physicians and Swiss Respiratory Society SGP. All Rights Reserved.


Chest. 2017;151(5_S):A29. doi:10.1016/j.chest.2017.04.032
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Extract

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown etiology characterized by the formation of submucosal nodules affecting the lumen of large airways. A 31-year old female was referred to pulmonary clinic for recurrent hemoptysis. She had a history of latent TB diagnosed at age 28 treated with INH for 6 months. Following treatment, she complained of intermittent cough and hemoptysis. She had 2 episodes of pneumonia within the same year that were treated with oral antibiotics. Sputum cultures obtained grew Pseudomonas aeruginosa and Klebsiella pneumoniae- unusual organisms in an otherwise healthy individual. 3 sputum samples were negative on AFB culture. Bronchoscopy revealed an abnormal trachea with nodular mucosal lesions on the anterior and lateral walls with sparing of the posterior walls. Bronchial washings returned positive for Mycobacterium avium intracellulare, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Biopsies of the nodular lesions showed marked inflammation with squamous metaplasia and focal dystrophic ossification but were negative for granulomas or malignancy. AFB and PAS stains were negative. A CT scan revealed scattered areas of mucous plugging, middle lobe bronchiolitis, and tracheal mucosal irregularity characteristic of TO. She was treated with ethambutol, rifampin, and azithromycin for 6 months with resolution of symptoms. She did well for 14 months but then developed hemoptysis without any other symptom. A follow up CT scan showed a new nodule and increase in nodular infiltrates in the right middle lobe. 8 sputum samples were sent for AFB smear and culture. 1 grew Mycobacterium fortuitum and the rest were negative. Bronchoscopy was again performed. Bronchial washings grew Pseudomonas aeruginosa and Klebsiella pneumoniae. AFB cultures were negative. Given recurrent infections, a workup for immunosuppression including HIV screening, and immunoglobulin levels were obtained and found to be within normal limits. The patient has remained asymptomatic and no recurrence of hemoptysis has been noted. No infection outside of the lungs has been observed.

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