Post-infectious Bronchiolitis Obliterans and Subpleural Cysts in a 30-month-old Boy with Down Syndrome
Post-infectious Bronchiolitis Obliterans and Subpleural Cysts
Vol. 14 No. 1 : 2019 (252-258)
Abstract
Post-infectious bronchiolitis obliterans is a rare disease that may occur following a microbiological insult towards the lower respiratory tract causing a severe form of chronic obstructive airway disease. Subpleural lung cyst may occur in 20-36% of Down syndrome. We report a case of a 30-month-old Down syndrome child who had interesting radiological concurrent findings of bronchiolitis obliterans with subpleural cysts on High Resolution Computed Tomography (HRCT) thorax. This patient was born premature and had early onset pneumonia during the neonatal period. Subsequently, he had three episodes of pneumonias at 18, 19 and 26 months. He presented with recurrent symptoms of cough, wheeze, rapid breathing and had features of persistent airway obstruction characterized by chest hyperinflation, persistent tachypnoea with crepitations and rhonchi despite on regular bronchodilators. The only positive culture was Influenza B from his nasopharyneal aspirate culture. To our knowledge, this is the first reported case with both radiological entities in a child with Down syndrome.
Keywords :
bronchiolitis obliterans,
Down syndrome,
subpleural cyst,
Correspondance Address
Associate Professor Dr Hasniah Abdul Latif. Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 5380 Email: hasniah@ppukm.ukm.edu.my
References
Benhaourech, S., Drighil, A., El Hammiri, A. 2016. Congenital heart disease and down syndrome: various aspects of a confirmed association, Cardiovascular Journal of Africa 27(5): 287-90.
Bertrand, P., Navarro, H., Caussade, S., Holmgren, N., Sanchez, I. 2003. Airway anomalies in children with down syndrome: endoscopic findings. Pediatric Pulmonol 36(2): 137-41.
Biko, D.M., Schwartz, M., Anupindi, S.A., Altes, T.A. 2008. Subpleural lung cysts in Down syndrome: prevalence and association with coexisting diagnoses. Pediatr Radiol 38(3): 280-4.
Cooney, T.P., Thurlbeck, W.M. 1982. Pulmonary hypoplasia in Down’s syndrome. N Engl J Med 307(19): 1170-3.
Epstein, C.J. 2001. Down syndrome (Trisomy 21). In: The metabolic and molecular bases of inherited disease, 8th edition. Edited by Valle D, Vogelstein B, Antonarakis SE, Gibson KM. Mc-Graw-Hill, New York; 1223.
Faizah, M.Z., Noorakmal, A., Syariz, I.S., Dayang, A.A., Tan, H.L. 2011. Recurrent epididymo-orchitis: a clinical presentation of posterior urethral valve in a child with Down Syndrome. Med & Health 6(1): 73-7.
George, M., Amodio, J., Lee, H. 2016. Cystic lung disease in Down syndrome: a case report and literature review. Case Reports in Paediatrics. 2016: 3 pages.
Gonzalez, O.R., Gomez, I.G., Recalde, A.L., Landing, B.H. 1991. Postnatal development of the cystic lung lesion of Down syndrome: suggestion that the cause is reduced formation of peripheral air spaces. Pediatr Pathol 11(4): 623-33.
Hilton, J.M., Fitzgerald, D.A., Cooper, D.M. 1999. Respiratory morbidity of hospitalized children with Trisomy 21. J Paediatr Child Health 35(4): 383-6.
Jones, K.L. 2006. Down syndrome. In: Smith’s recognizable patterns of human malformation. 6th edition, Elseviers Sauders, Philadelphia; 7.
Joshi, V.V., Kasznica, J., Ali Khan, M.A., Amato, J.J., Levine, O.R. 1986. Cystic lung disease in Down’s syndrome: a report of two cases. Pediatr Pathol 5: 79-86.
Kavaliunaite, E., Aurora, P. 2019 Diagnosing and managing bronchiolitis obliterans in children. Expert Rev Respir Med 13(5): 481-8.
Kim, C.K., Kim, S.W., Kim, J.S., Koh, Y.Y., Cohen, A.H., Deterding, R.R., White, C.W. 2001. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest. 120: 1101-6.
Kurland, G., Michelson, P. Bronchiolitis obliterans in children. 2005. Pediatr Pulmonol 39(3): 193-208.
Li, Y.N., Liu, L., Qiao, H.M., Cheng, H., Cheng, H.J. 2014. Post-infectious bronchiolitis obliterans in children: a review of 42 cases. BMC Pediatr 14: 238.
Moonnumakal, S.P., Fan, L.L. 2008. Bronchiolitis obliterans in children. Curr Opin Pediatr 20(3): 272-8.
Nurasyikin, Y., Shenaz, S.K., Suria, A.A., Azma, R.Z., Zarina, A.L., Hamidah, A., Salwati, S., Zubaidah, Z., Hamidah, N.H. 2012. Infantile acute megakaryoblastic leukaemia with t(1:22) in a non-Down syndrome child. Med & Health 7(2): 112-9.
Rasmussen, S.A., Wong, L.Y., Correa, A., Gambrell, D., Friedman, J.M. 2006. Survival in infants with Down syndrome, Metropolitan Atlanta, 1979-1998. J Pediatr 148: 806-12
Thillainathan, S., Sirisena, N. D., Kariyawasam, K. W. J. C., Jayasekara, R. W., Dissanayake, V. H. W. 2014. Cytogenetic analysis of chromosomal abnormalities in Sri Lankan children. World Journal of Pediatrics 11(4): 374-9.
Tyrrell, V.J., Asher, M.I., Chan, Y. 1999. Subpleural lung cysts in Down’s syndrome. Pediatr Pulmonol 28(2): 145-8.
van Trotsenburg, A.S., Heymans, H.S., Tijssen, J.G., de Vijlder, J.J., Vulsma, T. 2006. Comorbidity, hospitalization, and medication use and their infuence on mental and motor development of young infants with Down syndrome. Pediatrics 118(4): 1633-9.
Wang, W.P., Ni, Y.F., Wei, Y.N., Wei, Y.N., Li, X.F., Cheng, Q.S., Lu, Q. 2015. Bronchiolitis obliterans complicating a pneumothorax after Stevens Johnson syndrome induced by lamotrigine. J Formos Med Assoc 114(3): 285-9.
Yang, Q., Rasmussen, S.A., Friedman, J.M., 2002.Mortality associated with Down’s syndrome in the USA from 1983 to 1997: a population-based study. Lancet 359(9311): 1019-25.
Zhao, C., Liu, J., Yang, H., Xiang, L., Zhao, S. 2017. Mycoplasma pneumoniae-associated bronchiolitis obliterans following acute bronchiolitis. Sci Rep 7(1): 8478.
