ALL THAT WHEEZES IS NOT ASTHMA: BRONCHIAL STENOSIS IN DISGUISE

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SESSION TITLE: Allergy and Airway SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Bronchial stenosis is a rare condition usually presenting as a complication of sarcoid, tuberculosis, congenital lesions, traumatic injuries and inhalational injuries. Here we present a case of bronchial stenosis of unknown etiology initially presenting as asthma. CASE PRESENTATION: The patient was a 23-year-old female presented to the clinic with worsening symptoms of dyspnea, wheezing and dizziness. These symptoms remained refractory to inhaled corticosteroids and short acting β2 agonists. Her medical history included episodes of bronchitis consisting of cough and dyspnea worsened with exposure to cold air, dust and perfumes. She was diagnosed with asthma 5 years prior, controlled with inhaled corticosteroids and short acting β2 agonists. For her ongoing symptoms, she was on antibiotics and oral steroids with no relief. Physical examination was significant for audible wheezing, stridorous at times. Pulmonary function studies demonstrated moderately severe obstructive ventilatory defect. Laryngoscopy demonstrated normal motion of vocal cords. Serological studies, quantiferon and infectious work up returned negative. CT chest demonstrated narrowing of left main stem bronchus approximately 2 cm in length with the narrowest diameter being 3 mm. Fiberoptic bronchoscopy revealed concentric stricture of left main stem bronchus and inability to pass the therapeutic and diagnostic bronchoscopes past the stenosis. Endobronchial biopsies revealed changes consistent with chronic inflammation and no evidence of granulomas or capillaritis. Rigid bronchoscopy was performed with balloon dilatation and triamcinolone acetonide was inserted into the stricture. She remained symptom free for four months after the procedure. Rigid bronchoscopy with serial dilation was repeated due to recurrence of symptoms which re-demonstrated left main stem narrowing. The patient's symptoms have since resolved. DISCUSSION: Severe airway obstruction in a young patient is relatively unusual. Severe endobronchial anatomic changes are usually not suspected clinically. In these cases, radiographic findings or bronchoscopy are helpful in further evaluation. The absence of clinical, radiographic or pathologic evidence of either sarcoid, tuberculosis and vasculitides makes these diagnoses extremely unlikely in our case. This case demonstrates the possibility of milder forms of congenital bronchial stenosis escaping notice until late in life. CONCLUSIONS: This case typifies an old saying, “all that wheezes is not asthma". Bronchial stenosis should remain on the differential in a young person with airflow obstruction. Reference #1: Albert, RK and Petty, TL. Endobronchial tuberculosis progressing to bronchial stenosis. Chest. 1976; 70: 537–539 Reference #2: Westcott, JL and Noehren, TH. Bronchial stenosis in chronic sarcoidosis. Chest. 1973; 63: 893–897 DISCLOSURES: No relevant relationships by Muhammad Ali, source=Web Response No relevant relationships by Mark Barash, source=Web Response No relevant relationships by Stephen Dolan, source=Web Response No relevant relationships by UZAIR GHORI, source=Web Response No relevant relationships by Aasim Mohammed, source=Web Response No relevant relationships by Nabeel Siddiqui, source=Web Response