A Case Report Of "Productive Cough Diffuse Lung Lesion Excessive Mucus In Bronchioles"

Objectives:Report one undiagnosed case which has the characteristics of "persistent productive cough", diffuse lung lesion, pathological change shows " excessive mucus in bronchioles", to improve the ability of diagnosis and differential diagnosis of difficult cases,and emphasize the importance of follow-up.Methods:Report the detail of one case which has the clinical symptoms "persistent cough and sputum", chest CT shows "diffuse lung nodules, plaques, streaks shadow",lung biopsy pathology shows "excessive mucus in bronchioles"; summarize its diagnosis, treatment and follow-up; review the literature to discusse the diagnosis and differential diagnosis of it.Results:The patient is female,55years old,"cough, expectoration, intermittent fever for15days", came to Respiratory Medicine, Qilu Hospital of Shandong University in2013-9-13. Before came to our hospital chest CT showed diffuse lung nodules, plaques, streaks shadow, anti-infection treatment more than10days, she still hasd productive cough, and came to our hospital. After admission chest CT was taken and showed better than before, diagnosis was pneumonia, give anti-infection treatment.10days after admission, chest CT had no improvement compared with before. Thoracoscopic lung biopsy was taken, pathology report:"Does not rule out tuberculosis", then in2013-10-17isoniazid, rifampicin was taken and2013-10-23added pyrazinamide to anti-TB treatment then discharge and follow-up. Anti-TB treatment for nearly two months, the patient still had productive cough, chest CT did not change compared with the previous. Consultation from Beijing Xiehe Hospital of the lung biopsy pathology, reported as " excessive mucus in bronchioles".2013-12-12come to our clinic, as anti-tuberculosis treatment for almost2months, clinical, radiological and pathological didnot support tuberculosis, then anti-TB treatment was ended, oral prednisone30mg qd was given. Two weeks later (2013-12-25), CT chest had no change.Diffuse panbronchiolitis was considered and treated with oral azithromycin0.25g qd, the first week given5days and stop2days, from the second week taken for3days and stop4days every week. After three weeks (2014-1-15) follow-up, cough, sputum was better, chest CT did not improve; original plan to continue treatment for3months (2014-4-9), symptoms and radiographic improvement was not obvious. Still in follow-up now.Conclusions:(1) Pathology is the "gold standard" to diagnose the diffuse lung disease, but sometimes it can’t answer all the clinical questions;(2)Clinicians should pay more attention to diagnosis and treatment of bronchial mucus hypersecretion disease;(3) Close follow-up is an important method to diagnosis of difficult cases, clinicians must pay attention to and practice on it.