Idiopathic Follicular Bronchiolitis Presenting as Diffuse Cystic Lung Disease: Case Report
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Abstract
Idiopathic follicular bronchiolitis (FB) is a rare entity, whose manifestation as diffuse cystic lung disease is unusual. This case highlights the importance of its recognition in the differential diagnosis. We present the case of a 48-year-old, non-smoking, immunocompetent woman with chronic cough and progressive dyspnea. High resolution computed tomography revealed multiple pulmonary cysts, ground glass and mosaic attenuation. Functional tests showed severe obstruction with no bronchodilator response. Autoimmune diseases, immunodeficiencies and infections were ruled out by microbiological, serological and autoimmune studies. A surgical biopsy confirmed follicular bronchiolitis. Treatment with mycophenolate mofetil, prednisone and inhaled corticosteroids with long-acting beta-2 agonists was initiated, with clinical improvement. This case highlights the importance of including FB in the differential diagnosis of diffuse cystic lung diseases and the relevance of surgical biopsy to avoid misdiagnosis and optimize management. More evidence is needed on its evolution and response to immunosuppression in adults.
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