Since last September, the patient started having respiratory problems characterized by persistent cough. For this reason, he was treated first by the family doctor and then by local specialists but without any improvement of the symptoms. The parents thus turned to the Pneumology Centre.

After a series of tests aimed to determine the nature of the cough, the doctor compiled a final report which highlighted the following:

“The patient was initially treated with antibiotics with Clarithromycin since an infection from Mycoplasma pneumonia was suspected given the patient’s young age, but to no avail.

A high-resolution CAT scan of the thorax was then performed on the patient to survey the parenchyma, showing random micronodules resulting in a tree-in-bud pattern also in the subpleuric region in both areas.

Therefore, fiber bronchoscopy (FBS) with transbronchial biopsy, bronchial washing for cytometry and microbiological analysis for common flora and BK were performed: Anatomopathological report of mixed alveolar inflammation with evidence of fibromyxoid plugs in fibrous development; report compatible with BOOP.

BAL: 70% - NEUT: 20% - LYMPH: 5%.

The results for the analysis of respiratory function were normal.

Following the negative results of the microscope examination of BK, a progressive treatment with Deltacortene 25 mcg 1 tablet/day was started.

Recommended treatment: Steroid treatment

Diagnosis: BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA.

A PRF (respiratory function test) + DLCO test must be performed after approximately 3 months."

Since October 20, 2007, the patient started a cortisone treatment with Deltacortene 25 mg (1 tablet/day) + gastric inhibition with Limpidex 15 mg (2 tablets/day) which led to a reduction of cough symptoms; in early November, the cortisone dose was reduced to 12.5 mg/day and later, reduced to 10 mg and, finally, to 5 mg. After the dosage reduction, the patient started again, in the first week of the current month, to cough; the dosage was again increased to 25 mg/day and combined with a one-half dose of Trozocina 500 mg.

At the beginning of the cortisone treatment, the patient´s appetite increased and he gained 4 kg, while his complexion took on a pinkish hue that was at times quite intense.

At present, the coughing has subsided considerably, except for some sporadic attacks that occur two or three times a week.

Questions:

Do you confirm the diagnosis?

What, if any, other treatments do you recommend?

Can you recommend a specialized centre, possibly close to my place of residence?

Prognosis?

Medical opinion report

Thank you for referringthiscase for my medical second opinion.

This 16 year old boy was in good health conditiontill September 2007 when he started to coughwithout any preceding febrile illness. since than his cough became persistent and he was evaluated at the hospital of Imperia. His diagnostic workup included chest X-ray, lung CT and bronchoscpy with BAL.

Initially he was treated with clarithromycin for suspected atypical pneumonia, but with the persistent of the cough and the diagnostic procedure he was diagnosed as suffering from BOOP and corticosteroid was initiated with someclinically improvement but with side effect relating to the treatment.

to your question if I agree with the diagnosis, the answerer is not.

BOOP is rare disease in this age and both the clinical course and the attached chest -ray are not supporting the diagnosis. The chest ray showed only hyperinflation with mild peribronchial response. The lung function is normal and there is no report of any hypoxia or exertion difficulty.

Ithink he is suffering of post infectious hyperactive airway disease, a condition of respiratory symptoms post infection like Pertussis, this condition usually persist for few months and resolved.

Treatment for such condition consist of inhaled corticosteroid like BUDESONIDE 400 mcg twice a day with another course of 10 days of macrolide like clarithromycin or azithromycin.

As I mention before, the prognosis is usually good, much better thanthe prognosis ofBOOP