In May, 2005, a 40-year-old installer of thermohydraulic systems, who was a heavy smoker and had asthma, was referred to our hospital for progressive lung dysfunction of mixed type (Tiffeneau index 57%; forced expiratory volume in 1 s 1·73 L, 43% predicted; total lung capacity 5·75 L, 80% predicted; vital capacity 3·26 L, 64% predicted). He had a history of an acute episode of pneumonitis with asthma exacerbation and pleural effusion in March, 2005. High-resolution CT showed wandering bilateral nodular shadows, more obvious in the lower right apical lobe. Blood tests showed mild eosinophilia (11·7%; normal range 1·0–6·0), increased IgE (567 kU/L; 0–91), ESR (59 mm/h; 1–12), and C-reactive protein (31·1 mg/L; 0–5·0). All other laboratory results, including immunological markers, were within normal range. From the clinical (asthmatic and rhinitic symptoms), serological (eosinophilia), and CT (wandering bilateral nodular shadow) findings, a working diagnosis of Churg-Strauss syndrome was made. However, because of persistent eosinophilia, worsening dyspnoea, and persistent opacities on CT, the patient underwent bronchoscopy, bronchoalveolar lavage (BAL), and transbronchial biopsy (TBB).

An asthmatic patient with progressive lung dysfunction: a case of misdiagnosis.

CALABRESE, FIORELLA;ZUIN, RENZO;SAETTA, MARINA
2006

Abstract

In May, 2005, a 40-year-old installer of thermohydraulic systems, who was a heavy smoker and had asthma, was referred to our hospital for progressive lung dysfunction of mixed type (Tiffeneau index 57%; forced expiratory volume in 1 s 1·73 L, 43% predicted; total lung capacity 5·75 L, 80% predicted; vital capacity 3·26 L, 64% predicted). He had a history of an acute episode of pneumonitis with asthma exacerbation and pleural effusion in March, 2005. High-resolution CT showed wandering bilateral nodular shadows, more obvious in the lower right apical lobe. Blood tests showed mild eosinophilia (11·7%; normal range 1·0–6·0), increased IgE (567 kU/L; 0–91), ESR (59 mm/h; 1–12), and C-reactive protein (31·1 mg/L; 0–5·0). All other laboratory results, including immunological markers, were within normal range. From the clinical (asthmatic and rhinitic symptoms), serological (eosinophilia), and CT (wandering bilateral nodular shadow) findings, a working diagnosis of Churg-Strauss syndrome was made. However, because of persistent eosinophilia, worsening dyspnoea, and persistent opacities on CT, the patient underwent bronchoscopy, bronchoalveolar lavage (BAL), and transbronchial biopsy (TBB).
2006
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2438638
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