Abstract

Respiratory bronchiolitis is a histopathological lesion found in cigarette smokers, and is characterized by the presence of pigmented intraluminal macrophages within first-and second- order respiratory bronchioles. However, the condition may present as a form of interstitial lung disease with significant symptoms, abnormal pulmonary function and imaging abnormalities in rare cases, and named respiratory bronchiolitis associated interstitial lung disease (RB – ILD). We herein present a case with RB – ILD in our hospital. A 55-years-old male patient presented with cough and mild dyspnea. He has smoked 57 pack-years. Chest x-ray showed reticulonodular opacities with upper and middle zones predominantialy. The pulmonary function test was compatible with COPD: FVC 79%, FEV1 63%, FEV1/FVC 64%, PEF 70%, and FEF25-75 1.0 l/sec (27%). HRCT showed centrilobular ground-glass opacities. Eosinophils and neutrophils were increased in BAL. Brown pigmented macrophages and mononuclear cell infiltrations around the distal airways were observed in transbronchial biopsy. RB-ILD was diagnosed in the patient. The patient was stable after he stopped smoking, but he restarted later, and was lost to follow up.