An unusual case of chronic airflow obstruction in a heavy smoker

Authors

  • Attilio Cotroneo Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.
  • Maurizio Zompatori Unità di Pneumologia ed Unità di Diagnostica per Immagini, Ospedale San Giuseppe, IRCCS Multimedica, Milano.
  • Dario Familiari Unità Operativa Semplice Endoscopia toracica e Chirurgia toracica mininvasiva, AOU Policlinico “G.Martino”, Messina.
  • Francesco Nucera Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.
  • Federica Lo Bello Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.
  • Irene Coppolino Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.
  • Alfio Proietto Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.
  • Ignazio Salamone Unità Operativa Complessa di Diagnostica per Immagini, AOU Policlinico “G.Martino”, Messina.
  • Paolo Ruggero Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.
  • Sergio Harari Unità di Pneumologia ed Unità di Diagnostica per Immagini, Ospedale San Giuseppe, IRCCS Multimedica, Milano.
  • Francesco Monaco Unità Operativa Semplice Endoscopia toracica e Chirurgia toracica mininvasiva, AOU Policlinico “G.Martino”, Messina.
  • Gaetano Caramori Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), AOU Policlinico “G.Martino”, Messina.

DOI:

https://doi.org/10.6092/1828-6550/APMB.108.1.2020.CCS4

Keywords:

cystic lung disease, pulmonary Langherans Cell Histiocytosis, smoking, chronic airflow obstruction.

Abstract

We report here the case of a 49-year-old perimenopausal woman, current smoker of 30 pack-years, that was referred to our attention in our outpatient pulmonology clinic for the presence of progressive exertional dyspnea and persistent cough. In the last five years the patient has been seen in many different pulmonology outpatient clinics for the presence of chronic airflow obstruction and performed four computed tomography of the chest that showed the presence of a diffuse and bilateral cystic pattern in the lung parenchyma. After a careful differential diagnostic approach including medical history, lung function tests, laboratory exams and chest imaging reanalysis a diagnosis of pulmonary Langerhans Cell Histiocytosis was made with therapeutic recommendation of cigarette smoking cessation.

Chronic airflow obstruction and diffuse and bilateral cystic lung disease have many different causes. A complex differential diagnosis must be applied to every patient to understand the etiology and to provide the specific treatment.

References

1. Ahuja, J., Kanne J.P., Meyer, C.A., Pipavath S.N.J., Schmidt, R.A., Swanson J.O., Godwin J.D. (2015). Histiocytic Disorders of the Chest: Imaging Findings. RadioGraphics. 35, 357–370. doi:10.1148/rg.352140197.

2. Emile, J.F., Abla, O., Fraitag, S., Horne, A., Haroche, J.,Donadieu, J., Requena-Caballero, L., Jordan, M.B., Abdel-Wahab, O., Allen, C.E., Charlotte, F., Diamond, E.L., Maarten Egeler, R., Fischer, A., Herrera, J.G., Henter, J.I., Janku, F., Merad, M., Picarsic, J., Rodriguez-Galindo, C., Rollins, B.J., Tazi, A., Vassallo, R., Weiss, L.M. (2016). Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Blood. 127, 2672-2681. doi:10.1182/blood-2016-01-690636.

3. Gharsalli, H., Mlika, M., Sahnoun, I., Maalej, S., Douik El Gharbi, L., Mezni, F.E. (2018). The utility of bronchoalveolar lavage in the evaluation of interstitial lung diseases: A clinicopathological perspective. Semin in DiagnPathol. 35, 280-287. doi:10.1053/j.semdp.2018.08.003.

4. Lorillon, G., Tazi, A. (2017). How I manage pulmonary Langerhans cell histiocytosis. Eur Respir Rev. 6, 26(145). doi: 10.1183/16000617.0070-2017.

5. Schafernak, K.T., Thavarajah, K., Kalhan, R., Chou, P.M., Yeldandi, A.V. (2007). Pulmonary Langerhans Cell Histiocytosis. Clinical Pulmonary Medicine, 14(5), 265–277. doi:10.1097/cpm.0b013e3181514e61.

6.Young, L.R., Inoue, Y., McCormack, F.X. (2008) Diagnostic potential of serum VEGF-D for lymphangioleiomyomatosis. NEngl J Med. 358(2), 199–200.Epub 2008/01/11. 358/2/199doi.org/10.1056/.

7. Vassallo, R., Ryu, J.H., Schroeder, D.R., Decker, P.A., Limper, A.H. (2002). Clinical outcomes of pulmonary Langerhans’-cell histiocytosis in adults. NEngl J Med.346(7),484-490. doi:10.1056/NEJMoa012087.

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Published

2020-06-18

Issue

Vol. 108 No. 1 (2020)

Section

CLINICAL CASE SEMINAR

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