A child with a foreign body in bronchus misdiagnosed as asth
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An 11-year-old boy was brought with complaints of recurrent cough, tightness of chest, and breathing difficulty for the last 18 months. The child was a product of nonconsanguineous parents. The child was asymptomatic 18 months prior and doing well. Developmentally, he was normal. Eighteen months back, the child developed a sudden onset cough, wheeze, and fever for which he was diagnosed as pneumonia and treated with oral antibiotics. Later on, the child had repeated reoccurrence of symptoms for which he received several courses of oral antibiotics (amoxicillin, clavulanic acid) along with bronchodilators (oral salbutamol syrup) and nebulization (salbutamol, ipratropium bromide, and budesonide).

The child visited after one year of the onset of symptoms with frequent similar episodes of cough and breathing difficulty (weekly night time symptoms). The anthropometric examination was appropriate for his age. On chest examination, there were diffuse rhonchi heard. A chest X-ray showed hyperinflation along with infiltrates on the right lung field. He was prescribed oral antibiotics, B2 agonist, and steroid nebulization. The child responded well to the treatment, but symptoms reoccurred again after one week. He was then diagnosed as a case of moderate persistent asthma (based on night-time weekly symptoms, eosinophil count, 10%, and improvement with inhaled B2-agonist along with spirometry findings for asthma). Further, the chest CT was done, which showed features suggestive of mucus impaction.

Flexible bronchoscopy was planned and performed under intravenous sedation, which showed a foreign body (chicken meat) residing on right bronchus intermedius along with soft tissue growth mobile during coughing. The soft tissue growth was seen in the division of bronchus intermedius, partially obliterating both middle and lower lobe bronchus (Figure 3). The chicken meat (size about 5 mm) was removed from the right bronchus intermedius along with granulation tissue. An endobronchial biopsy was obtained and sent for histopathological examination along with the foreign body. Biopsy report showed benign bronchial tissue with a bit of granulation tissue from the endobronchial specimen and bacterial colonies with few epithelial cells from the foreign body.

The child was discharged on oral antibiotics for one week. Follow-up after one week showed improvement in the respiratory symptoms with normal chest examination findings. The child was again followed up in a three-month interval where he was found to be asymptomatic with normal examination findings.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3153
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