Tracheobronchopathia Osteochondroplastica: a rare case report of a non-smoker and non-atopic patient, with a long history of wheezing since childhood.
BACKGROUND
Tracheobronchopathia Osteochondroplastica (TBPO) is an uncommon and benign condition characterized by osseous or metaplastic cartilaginous 1-3 mm nodules in the submucosa of the tracheo-bronchial tree. Posterior membranous wall of trachea is typically spared. Ecchondrosis and exostosis nodules can cause chronic inflammation and mucosal metaplasia, stiffness and airway obstruction. The prevalence of this disease, often asymptomatic or associated with nonspecific symptoms, is underestimated, and the mean age at diagnosis is 50 years.


METHODS
We report a case of a 49 year old male, non-smoker. He was a smith, homeless, born in Romania and reported a diagnosis of asthma since childhood. He was admitted to our Respiratory Unit presenting low-grade fever with profuse sweating, cough, purulent sputum, and ground-glass opacity with irregularity in main bronchi detected by High-Resolution Computed Tomography (HRCT) scan. Fibrobronchoscopy revealed the presence of mucosal irregularities up to the segmental bronchi entrance. Histological examination showed nodules of osseouscartilaginous nature, consistent with TBPO. Microbiological tests of Bronchoalveolar Lavage fluid also revealed an infection by Pseudomonas Aeruginosa.


CONCLUSIONS
TBPO is a rare disease characterized by wheezing, cough, hemoptysis, and recurrent pulmonary infections, with typical onset during adulthood. In the case reported, the symptoms began in childhood, although they had been misinterpreted as asthma. Even if childhood-onset is not reported in literature, it is likely that small changes occur in the first few years of life and become more evident in adulthood. The involvement of segmental and sub-segmental bronchi, usually spared in TBPO, could explain the presence of wheezing and non-productive cough reported by our patient since childhood.
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Alessandro G
AG
Fois
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Antonella
A
Arcadu
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Luigi
L
Santoru
Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
Rocco
R
Trisolini
Pathology Unit, University of Sassari, Sassari, Italy.
Vincenzo
V
Marras
Department of Clinical and Experimental Medicine, Surgical Clinic, University of Sassari, Sassari, Italy.
Giorgio C
GC
Ginesu
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Sara
S
Canu
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Lorenzo
L
Cordero
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Gabriella
G
Diana
Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy.
Pietro
P
Pirina
Rare diseases; Respiratory sounds; Tracheal disease; Tracheobronchopathia Osteochondroplastica