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Post-infectious Bronchiolitis Obliterans and Subpleural Cysts in a 30-month-old Boy with Down Syndrome

Case report

Abstrak

Post-infectious bronchiolitis obliterans adalah penyakit yang jarang berlaku. Ianya disebabkan oleh jangkitan saluran respiratori bawahan yang kerap, yang menyebabkan saluran pernafasan menjadi sempit secara kronik. Manakala, subpleural cysts ditemui hanya pada 20-36% pesakit sindrom Down. Kami melaporkan kes seorang kanak-kanak sindrom Down berumur 30 bulan yang mempunyai penemuan menarik pada radiograf HRCT toraks yang menunjukkan dua ciri iaitu bronchiolitis obliterans dan subpleural cysts. Pesakit yang dilahirkan pramatang ini menghidapi jangkitan paru-paru selepas lahir dan kemudiannya mendapat tiga lagi episod jangkitan paru-paru pada umur 18, 19 dan 26 bulan. Beliau mempunyai gejala batuk yang kronik, pernafasan laju dan berbunyi. Pada pemeriksaan fizikal, terdapat tanda-tanda yang menunjukkan masalah saluran pernafasan tersekat yang kronik. Sampel kahak dari nasofarinks didapati positif virus Influenza B. Setakat pengetahuan kami, ini merupakan laporan pertama tentang kewujudan kedua-dua entiti radiologi tersebut pada seorang kanak-kanak sindrom Down.

Abstract

Post-infectious bronchiolitis obliterans is a rare disease that may occur following a microbiological insult towards the lower respiratory tract causing a severe form of chronic obstructive airway disease. Subpleural lung cyst may occur in 20-36% of Down syndrome. We report a case of a 30-month-old Down syndrome child who had interesting radiological concurrent findings of bronchiolitis obliterans with subpleural cysts on High Resolution Computed Tomography (HRCT) thorax. This patient was born premature and had early onset pneumonia during the neonatal period. Subsequently, he had three episodes of pneumonias at 18, 19 and 26 months. He presented with recurrent symptoms of cough, wheeze, rapid breathing and had features of persistent airway obstruction characterized by chest hyperinflation, persistent tachypnoea with crepitations and rhonchi despite on regular bronchodilators. The only positive culture was Influenza B from his nasopharyneal aspirate culture. To our knowledge, this is the first reported case with both radiological entities in a child with Down syndrome.