Results of pulmonary function tests (Table 1) showed moderate airway obstruction, a significant response (20.4 percent rise in FEVj) to inhaled salbutamol administration, and air trapping. The chest roentgenogram revealed patchy infiltrates in both lungs (Fig 1). Bronchoscopy was performed and showed evidence of bronchitis bilaterally. Bilateral bronchograms showed no evidence of bronchiectasis, and a Gram stain of the sputum showed many white cells but no organisms. The sputum cytologic study was negative for malignant cells, and acid-fast smears were negative. An intermedi-ate-strength PPD produced no induration. Because of uncertainty about the cause of the pulmonary infiltrates, an open lung biopsy was performed in November 1982. Stains for Pneumocystis carinii, mycobacterial, and fungal organisms were negative, and cultures of the biopsy specimens grew no organisms. Histologic examination showed diffuse panbronchiolitis (Fig 2) without granulomata. The inflammatory infiltrate in the alveolar walls (Fig 3) consisted of small lymphocytes and plasma cells. This histologic picture of panbronchiolitis conformed with the criteria outlined by Homma et al. fully
The patient was discharged receiving daily bronchodilators and prednisone therapy and did well until late 1984 (60 months after his initial presentation), when he noted the onset of his intestinal symptoms. Prior to proctocolectomy, attempts to reduce his daily prednisone below 10 mg/day resulted in return of both intestinal and pulmonary symptoms. However, for four months after proctocolectomy, he remained stable without corticosteroid therapy (both inhaled and systemic) and was free of pulmonary symptoms. Beginning in the fifth month after proctocolectomy, slight cough and wheezing returned, although his chest roentgenogram remained normal. Corticosteroid therapy was reinstituted with good control of his pulmonary symptoms.
Table 1—Pulmonary Function Results
|Pulmonary Test||August 1982 (% pred)||November 1982 (% pred)||July 1987 (% pred)||February 1988 (% pred)|
|Dsb, ml/m/mm Hg||30||(88)||34||(100)||24||(81)||—|
|Po2, mm Hg||—||—||80||77|
Figure 1. Chest roentgenogram from Nov 19, 1982, showing bilateral patchy infiltrates.
Figure 2. Inflammatory infiltrate involving a bronchiole and extending into the adjacent interstitium of pulmonary parenchyma. Although inflamed, the bronchiolar architecture is preserved (HandE, x80).
Figure 3. Inflammatory infiltrate in bronchiolar wall composed of small lymphocytes and plasma cells (H and E, x 320).