Case report of tracheobronchopathia osteochondroplastica

Abstract

Introduction: Tracheobronchopathia osteochondroplastica (TPO) is a rare entity characterized by bony and cartilaginous submucosal nodules which project into the tracheal–bronchial lumen. Nodules sometimes reach to the main bronchus and rarely to larynx. The disorder is more common in men and the diagnosis is usually made in the fourth through sixth decades of life. It's etiology remains unknown, with no relationship to smoking or systemic disorders. The patients are only rarely symptomatic since severe airway obstruction is unusual. Nevertheless the clinic is characterized by cough, dyspnea and recurrent respiratory infections. Even though imaging studies and bronchoscopy may indicate the diagnosis, the diagnosis is histological. There is only symptomatic therapy available. Methods: We report a case of an 81 year old men, with past history of auricular fibrillation, hypertension and heart failure who presented with recurrent respiratory infections treated with different courses of antibiotics. He was hospitalized due to community acquired pneumonia, with fever (37.8 °C), productive cough, yellow sputum, dyspnea and wheezing. He was treated with Ceftriaxone and Clarithromycin, completing 10 days of therapy. No agent was isolated. At the time of discharge we presented only with dry cough. One week after, he was readmitted for the same symptoms. Laboratory tests revealed mild leukocytosis and slight PCR elevation. The chest X-ray revealed right pleural effusion. Blood cultureswere negative. He started broad spectrumantibioticwith Piperacillin–Tazobactam, completing 10 days. Thoracocentesis revealed exudative effusion, with negative cultures. On the control X-ray there was a reduction of the effusion. Two days after, we noticed diminished breath sounds on physical examination, so another X-ray was performed, presenting a large pleural effusion, as we saw at the beginning. Regarding the medical history of the patient, the exudative nature of the effusion we performed bronchoscopy that showed cartilaginous submucosal nodules of the tracheal submucosa, consistent with tracheobronchopathia osteochondroplastica. Conclusions: TPO is a rare entity, characterized by bony and cartilaginous submucosal nodules which project into the tracheal–bronchial lumen, being more frequent in males being in the majority of the cases asymptomatic. In our case, regarding the age of the patient and the medical history, we think that this pathology favors the recurrent respiratory infections.