Klubdaeng A, Tovichien P. Diffuse panbronchiolitis in children misdiagnosed as asthma: A case report. World J Clin Cases 2025; 13(14): 103501 [DOI: 10.12998/wjcc.v13.i14.103501]
Corresponding Author of This Article
Prakarn Tovichien, MD, Associate Professor, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand. prakarn.tov@mahidol.edu
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 16, 2025; 13(14): 103501 Published online May 16, 2025. doi: 10.12998/wjcc.v13.i14.103501
Diffuse panbronchiolitis in children misdiagnosed as asthma: A case report
Anuvat Klubdaeng, Prakarn Tovichien
Anuvat Klubdaeng, Prakarn Tovichien, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Klubdaeng A and Tovichien P contributed equally to the study; Klubdaeng A and Tovichien P contributed to data collection, writing, and editing of this manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient to publish this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prakarn Tovichien, MD, Associate Professor, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand. prakarn.tov@mahidol.edu
Received: November 25, 2024 Revised: December 19, 2024 Accepted: January 2, 2025 Published online: May 16, 2025 Processing time: 55 Days and 1.5 Hours
Abstract
BACKGROUND
Diffuse panbronchiolitis (DPB) is a rare, chronic inflammatory lung disease marked by chronic cough, breathlessness, and preceding sinusitis. Symptoms often persist for years and can be misdiagnosed as asthma, particularly in children. This report describes a DPB case resolved with long-term azithromycin therapy, emphasizing the need for a timely and accurate diagnosis.
CASE SUMMARY
A 12-year-old girl, diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists, developed a history of chronic productive cough and chronic sinusitis for a year. On examination, she exhibited wheezing and coarse crackles. Despite receiving treatment for an asthma exacerbation, her symptoms did not improve. A chest X-ray revealed reticulonodular infiltration in both lower lungs, prompting further evaluation with high-resolution computed tomography (HRCT). The HRCT confirmed centrilobular nodule opacities, a 'tree-in-bud' pattern, and non-tapering bronchi, suggesting DPB. Elevated cold hemagglutinin titers at 128 further supported the diagnosis. Her cough and sinusitis resolved within a month after starting azithromycin therapy, chosen for its anti-inflammatory and immunomodulatory effects. Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.
CONCLUSION
This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
Core Tip: Diffuse panbronchiolitis presents progressively worsening symptoms such as chronic cough, shortness of breath during exertion, and persistent sinus infections. Often misdiagnosed as asthma, the condition can be identified through purulent sputum history or squawks detected during auscultation. Prompt and accurate diagnosis ensures effective treatment and improved clinical outcomes.
