Pediatric follicular bronchiolitis with severe atelectasis: a case report

Abstract

Follicular bronchiolitis is a rare pulmonary disorder characterized by the presence of multiple hyperplastic lymphoid follicles with a peribronchiolar distribution. An 11-year-old girl with total atelectasis of the right middle lobe (RML) and diffuse multiple small nodules at both lung bases presented to our hospital with frequent upper respiratory infections and pneumonia. The disease progressed during a 3-month period of macrolide therapy, and thoracoscopic biopsy with lobectomy of the atelectatic RML was performed. The histopathologic diagnosis was follicular bronchiolitis. The patient's pulmonary function improved dramatically after oral steroid treatment. It can be difficult to diagnose follicular bronchiolitis based solely on clinical, laboratory, and radiologic findings; the disorder must be confirmed histopathologically. A patient with longstanding irreversible atelectasis and resulting recurrent respiratory infection may require lobectomy for the diagnosis and treatment of follicular bronchiolitis.

Keywords: Follicular bronchiolitis; atelectasis; lobectomy; pediatrics.

Figure 1

Chest radiograph shows multiple poorly defined nodular lesions in both lower lung fields.

Figure 2

Chest computed tomography shows atelectasis (arrow) and bronchial dilatation in the right middle lobe (A) and multiple centrilobular nodules (arrow heads) and bronchiectasis in both lower lobes (B).

Figure 3

The macro- and microscopic findings of the resected lung. The cut surface of the right middle lobe exhibits scattered small yellowish nodules (A). There is diffuse infiltration of inflammatory cells and lymph follicles (arrows) (hematoxylin and eosin [H&E], ×40) (B). Chronic inflammatory cells and well developed lymph follicles (arrows) are located in peribronchiolar area (H&E, ×100) (C). The infiltrated chronic inflammatory cells are composed of small lymphocytes and plasma cells. Interstitial infiltration of foamy macrophages is focally identified (H&E, ×200) (D).