A 45 Year old woman a known case of SLE Presents With Worsening Dyspnoea...

A 45-yr -old woman known to suffer from (SLE) is referred to the chest clinic with a history of worsening dyspnoea. She is on a maintenance dose of 15 mg of prednisolone. She has never smoked, and according to her she developed an unproductive cough and dyspnoea three months ago. There is no history of fever, night sweats or weight loss. Her doctor has tried various types of inhalers with no benefit.  A PEFR diary shows no nocturnal dips.
A Chest X Ray shows a reticulonodular pattern.
Examination is unremarkable apart from the skin changes of SLE.

What is the most likely Diagnosis?
A. Asthma
B. Bronchiectasis
C. Bronchiolitis obliterans
D. TB
E. Fungal infection

Answer:
C. Bronchiolitis obliterans

Discussion: ‘Bronchiolitis obliterans’ is the term used to describe fibrous scarring of the small airways.

Etiology: It is seen following: toxic-fume inhalation; mineral-dust exposure; viral infection; mycoplasma and legionella infection; bone marrow, heart–lung and lung transplantation; RA; SLE; and as a side effect of penicillamine.

Clinical features: It presents as a dry cough and dyspnoea. Physical examination is unremarkable. Expiratory wheeze may be audible.

Diagnosis: The Chest X Ray findings can vary from normal to a reticular or reticulonodular pattern. The Dignosis can be confirmed by lung biopsy.

Treatment: Patients rarely respond to steroids. The prognosis is poor.