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DOI: 10.1055/s-2006-958891
Drug induced severe obstructive bronchiolitis (OB): a case report
Background: Sudden onset and persistence of bronchial obstruction suggest asthma or COPD exacerbation. In differential diagnosis some other causes should be considered. We report a 49-year old male, non-smoker with dry cough and severe dyspnoea on exertion.
Case history: 49-year old male, non-smoker got ill two weeks before admission with dry cough, severe dyspnoea on exertion and chest tightness. Symptoms were present only during the day. No sputum production was observed. M. Crohn was diagnosed 4 months ago and treated with high doses of sulphasalazine (1500mg daily). Gastrointestinal symptoms regressed while respiratory ones deteriorated progressively.
Diagnostic results: On chest X-ray pronounced hyperinflation of the lung was observed. Lung function tests showed marked restrictive-obstructive pattern (VC 70%, FEV1 55%, RV 219%, FRC elevated as well, DL,CO normal). BAL revealed elevated lymphocyte-neutrophil cell count, with CD8+ lymphocyte prominence. In arterial blood hypoxemia was present. Usual bronchodilatators and inhaled corticosteroids were inefficient.
Therapy: Sulphasalazine was discontinued and methylprednisolone in initial dose of 32mg daily entered the therapy. Steroids were tapered down and dyspnoea disappeared within 4 weeks. Control lung function tests after 4 weeks were normal, and the patient no more hypoxemic. It turned out that diagnosis of M. Crohn was not really confirmed, so sulphasalazine was no longer necessary.
Conclusion: In the differential diagnosis of obstructive lung disease also drug induced obstructive bronchiolitis should be considered. Case history should include questions about drugs capable of causing OB. OB should be considered especially, when usual antiobstructive therapy is inefficient.