Mycoplasma pneumoniae-Associated Bronchiolitis Obliterans Following Acute Bronchiolitis

Abstract

The characteristics of Mycoplasma pneumonia (M. pneumoniae)-associated bronchiolitis obliterans (BO) are not well known. We retrospectively reviewed 17 patients with M. pneumoniae-associated BO. All patients had M. pneumoniae-associated acute bronchiolitis prior to the development of BO. In the acute bronchiolitis stage, all patients had fever and cough; six patients also had wheezing and dyspnoea. BO was diagnosed approximately 1.5-8 months later based on clinical manifestations and chest high-resolution computed tomography (HRCT) findings. All patients presented with wheezing and/or dyspnoea at the time of diagnosis of BO. HRCT findings included mosaic attenuation, pronounced air trapping, central bronchiectasis and emphysema, according to disease severity. Lung function tests revealed mild to severe airway obstruction. Fourteen of 17 patients had a greater than 12% increase in forced expiratory volume in 1 second values after taking salbutamol. All patients had positive allergy test results and family or personal history of atopic disease. Four patients had a history of asthma before M. pneumonia bronchiolitis. Asthma was diagnosed before, at the time of or after the diagnosis of BO in 11 cases. M. pneumoniae-associated BO may therefore develop following M. pneumonia bronchiolitis and overlap with asthma.

Figure 1

Representative HRCT and Bronchoscopy findings of a patient with moderate disease. (a) HRCT showing inflammatory bronchiolitis. (b) HRCT showing mosaic patterns, bronchiectasis and left lung hyperlucency. (c) Bronchoscopy showing a partially occluded lumen in segmental bronchi. (d) HRCT showing BO after 4 years of treatment.

Figure 2

Representative HRCT and Bronchoscopy findings of a patient with severe disease. (a) HRCT showing inflammatory bronchiolitis. (b) HRCT showing mosaic patterns as well as marked bronchiectasis. (c) Bronchoscopy showing a completely occluded lumen in segmental bronchi. (d) HRCT showing BO after 4 years of treatment.