Abstract :
Chronic micro aspiration to the lungs can lead to a wide spectrum of manifestations ranging from inflammatory changes to irreversible damage in the form of fibrosis, bronchiectasis, and cavitation leading to Diffuse Aspiration Bronchiolitis (DAB). A significant number of DAB patients goes undiagnosed without clinical suspicion because of atypical presentation. In this report, DAB secondary to oesophageal webs, as part of Plummer-Vinson syndrome is described. Plummer-Vinson syndrome (PVS) is a triad constituting dysphagia, oesophageal web, and iron deficiency anaemia. Even though DAB has been described in patients with predisposing factors like neurological disorders, Gastro Oesophageal Reflux disease (GERD) etc. Plummer Vinson Syndrome has never been reported as a cause in previous literature.
A 56-year-old lady, known case of Plummer Vinson syndrome presented with history of cough and expectoration of purulent sputum for last 10 days. On examination, patient had pallor and bilateral basal crepitations were heard on auscultation. On evaluation, her HRCT thorax showed bilateral lower lobe bronchiectasis with tree in bud opacities and left lower lobe cavitation. Sputum examination was negative for AFB staining and culture revealed growth of Klebsiella pneumoniae. Bronchoscopy showed thick purulent secretions from both lungs. She had microcytic hypochromic anaemia with low iron stores. A diagnosis of Diffuse Aspiration pneumonitis (DAB) secondary to oesophageal web has been made. Patient was treated with antibiotics as per the susceptibility pattern, chest physiotherapy and postural drainage and other symptomatic and supportive measures. Oesophageal web dilatation was done. Iron deficiency anaemia was corrected using parenteral iron therapy followed by oral iron. A proper patient education and counselling was done about the prophylactic measures to be adopted to prevent chronic aspiration.
Diffuse Aspiration Bronchiolitis (DAB) is an underrecognized clinical entity which occurs secondary to a variety of predisposing conditions. Oesophageal dysfunction is one of the most common predisposing factors which in turn can be due to multiple causative factors. Plummer Vinson syndrome is one such rare cause. It is important to evaluate and identify iron deficiency anaemia and early DAB as a complication in such patients. This can help in adopting essential prophylactic measures like correction of iron deficiency and endoscopic dilatation of oesophageal web. This can prevent chronic micro aspiration and the irreversible lung damage which can cause long term pulmonary morbidity.
Keyword :
Aspiration, Bronchiolitis, Oesophageal web