IMAGES IN CLINICAL MEDICINE
Eosinophilic Bronchitis
Yanhong Ren, M.D., Ph.D., and Huaping Dai, M.D.
N Engl J Med 2017; 377:873
DOI: 10.1056/NEJMicm1616156
A 43-year-old woman presented with an 8-month history of progressively worsening nonproductive cough. She had been treated with antibiotic agents for presumed bronchitis, but her cough continued to worsen. Her vital signs were normal, the pulmonary examination was notable for wheezing in both lungs, and the white-cell count, including the absolute number of eosinophils, was normal. Results of pulmonary-function tests suggested an obstructive defect that did not respond to bronchodilators. Bronchoscopy revealed diffuse nodules in the tracheobronchial mucosa (Panel A). Biopsy of a nodule revealed eosinophilic infiltration of the bronchial mucosa. There was no evidence of tumor, infection, vasculitis, or granulomas. The patient received a diagnosis of eosinophilic bronchitis. Patients with eosinophilic bronchitis usually have normal results on spirometry, but diffuse nodules in the tracheobronchial mucosa cause obstruction that does not respond to bronchodilators. The patient was treated with systemic glucocorticoids and inhaled budesonide for 1 month. At 1 month after the start of therapy, follow-up bronchoscopy revealed a considerable decrease in the size of the nodules in the tracheobronchial mucosa (Panel B), repeat pulmonary-function tests revealed resolution of the obstructive defect, and the patient’s clinical symptoms had resolved completely. Because small nodules were still visible, the patient received inhaled budesonide for 2 additional months, after which the mucosal nodules in the trachea were no longer present. At follow-up 6 months after the start of therapy, the clinical symptoms had not recurred.
一名43岁女性患者因进行性加重干咳8个月就诊。患者因怀疑支气管炎使用抗生素治疗，但咳嗽持续加重。生命体征正常，肺部检查发现双侧哮鸣音，白细胞计数包括嗜酸细胞绝对值均正常。肺功能检查提示阻塞性通气功能障碍且对支气管扩张剂无反应。支气管镜检查发现气管支气管粘膜弥漫性结节（图A）。结节活检显示支气管粘膜有嗜酸细胞浸润。没有发现肿瘤、感染、血管炎或肉芽肿表现。患者诊断为嗜酸细胞性支气管炎。嗜酸细胞性支气管炎患者的肺功能检查结果通常正常，但气管支气管粘膜弥漫性结节可导致梗阻且对支气管扩张剂无反应。患者接受全身皮质激素及吸入布地奈德治疗1个月。一个月后复查支气管镜发现，气管支气管粘膜的结节有明显缩小（图B），复查肺功能显示气道梗阻缓解，患者临床症状完全消失。因为仍可见到小结节，患者继续吸入布地奈德2个月，此后气管粘膜结节完全消失。开始治疗后6个月随访时临床症状没有复发。
