Abstract
IntroductionClubbing is very uncommon in respiratory bronchiolitis-associated interstitial lung disease, and primarily raises the suspicion of idiopathic pulmonary fibrosis in a patient presenting with diffuse parenchymal lung disease. If idiopathic pulmonary fibrosis can be excluded, clubbing should raise the suspicion of an occult tumour.Case presentationWe describe a heavy smoker presenting with dyspnea and severe clubbing. Surgical lung biopsy revealed the histologic diagnosis of respiratory bronchiolitis-associated interstitial lung disease. Respiratory bronchiolitis-associated interstitial lung disease is a distinct clinicopathologic entity within idiopathic interstitial pneumonia patients described almost exclusively in cigarette smokers. The disease is associated with a good prognosis and mild symptoms but not with clubbing. After smoking cessation the radiologic findings of interstitial lung disease improved in parallel with improvement in lung function and gas exchange. However, a central squamous cell carcinoma was detected in the follow-up.ConclusionIn this case, clubbing was most probably caused by the occult tumor rather than by respiratory bronchiolitis-associated interstitial lung disease.
Highlights
Introduction: Clubbing is very uncommon in respiratory bronchiolitis-associated interstitial lung disease, and primarily raises the suspicion of idiopathic pulmonary fibrosis in a patient presenting with diffuse parenchymal lung disease
Case presentation: We describe a heavy smoker presenting with dyspnea and severe clubbing
Clubbing in itself is very uncommon in respiratory bronchiolitisassociated interstitial lung disease (RB-ILD), and primarily raises the suspicion of idiopathic pulmonary fibrosis (IPF) in a patient presenting with diffuse parenchymal lung disease (ILD)
Summary
Cigarette smoking is a well-recognized cause of a variety of lung diseases, including interstitial lung disease. Case presentation A 55-year-old Caucasian who had been a heavy smoker (up to 40 cigarettes per day) over 37 years reported to our outpatient clinic because of increasing dyspnea and persistent cough. HRCT showed diffuse ground glass opacities predominantly involving the lung bases, and subpleural fibrosis (Figure 2). HR-CT showing diffuse ground glass opacities predominantly involving the lung basis This aspect being consistent with the clinical finding of fine inspiratory basal crackles at auscultation. There was thickening of the bronchiolar walls by smooth muscle hypertrophy and mild edema, but no evidence of alveolar interstitial fibrosis, and no evidence of lung cancer These histologic findings, together with the clinical features were interpreted as RB-ILD. The patient was staged and chemotherapy was applied for the following 18 months, until the patient died, 42 months after initial presentation
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