title: Diffuse panbronchiolitis: an underdiagnosed disease? Study of 4 cases in Brazil.
abstract: BACKGROUND
  Diffuse panbronchiolitis is a clinical pathologic condition characterized by chronic inflammation of respiratory bronchioles, with clinical features that position it as a differential diagnosis among the sinopulmonary syndromes.
  
  
  RESULTS
  We present 4 cases (1 Black, 2 Japanese descendants, and 1 Japanese), living in Brazil, in which the diagnosis was made by the clinical and radiological features and confirmed by transbronchial biopsy. The clinical findings included chronic sinusitis, productive cough, rhonchi, and wheezes. The pulmonary function tests showed an obstructive pattern. High resolution computerized tomography showed a diffuse nodular pattern, airway ectasia, and airway wall thickening. The biopsy showed interstitial accumulation of foam cells and lymphoid cells in the walls of respiratory bronchioles: 2 of our cases had bronchus-associated lymphoid tissue hyperplasia. We searched for the HLA Bw54 in all of our patients, but only 1 was positive. A low dose macrolide treatment was introduced, resulting in with clinical and functional improvement. A score that rated the extent of nodules, airway ectasia, mucus plugging, and airway wall thickening was applied on pre- and post-treatment High resolution computerized tomography results, revealing an improvement in tomographic pattern related to that observed in the pulmonary function tests.
  
  
  CONCLUSIONS
  We conclude that diffuse panbronchiolitis is a systemic disease that is not exclusive to the Asian population, whose clinical and radiological features should be better known by occidental pulmonary physicians.
authors.affiliation: Pulmonary Division, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Souza
authors.forename: Ronaldo Adib
authors.initials: RA
authors.lastname: Kairalla
authors.forename: Ubiratan de Paula
authors.initials: Ude P
authors.lastname: Santos Ud
authors.forename: Teresa Yae
authors.initials: TY
authors.lastname: Takagaki
authors.forename: Vera Luiza
authors.initials: VL
authors.lastname: Capelozzi
authors.forename: Carlos Roberto Ribeiro
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil; D001988:Bronchiolitis / Q000175:diagnosis* / Q000188:drug therapy; D017291:Clarithromycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004917:Erythromycin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin; D017291:Clarithromycin