Respiratory bronchiolitis associated with interstitial lung disease: Case report

Respiratory bronchiolitis associated with interstitial lung disease (RB-ILD) is a recently described clinicopathological entity that occurs almost exclusively in current heavy cigarette smokers. RB-ILD characterized histologically by bronchiolocentric accumulation of pigmented alveolar macrophages and fibrotic or cellular inflammatory changes of pulmonary interstitium. Patients with RB-ILD commonly present with productive/nonproductive cough and dyspnea, fever, sweat and chest tightness. Auscultation of the lungs reveals inspiratory crackles in about half of patients. Haemoptysis is uncommonly a symptom in a patient with RB-ILD. The patient was a 21 year old man, who was admitted to the hospital for hemoptysis, productive cough, moderate dyspnea, sputum expectoration, weight loss and peripheral cyanosis. He neither had a relevant medical history before, nor a family history of respiratory system illness. He had 2 pack-year smoking history. Auscultation of the lungs revealed bilateral infrascapular crackles. Arterial blood gases on room air showed PaO2 48 mmHg, PaCO2 37 mmHg and SpO(2) 70%. Pulmonary function results showed restrictive pattern. High-resolution computed tomography (HRCT) scan findings in our case are centrilobular nodules, ground glass opacities at both lung, minimal effusion and pleural thickening at the right major fissure, thickening of peribronchovascular walls and atelectatic band formations at middle lobe of right lung in the paracardiac area. Histopathological examination of the specimens taken by open lung biopsy was compatible with RP-ILD. Clinical and radiological findings of the patient improved spontaneously after smoking cessation and did not need corticosteroid.