Clinical and Bronchoscopic Manifestations
In this study, disease course was assessed based on clinical
manifestations, lung imaging, and bronchoscopic findings then was
classified into three disease course categories: acute-stage,
subacute-stage, and recovery-stage.
Symptoms during acute-stage SMPP included fever, elevated CRP, and large
areas of consolidation detected via lung imaging. Generally, detection
of bronchial mucosal congestion with or without airway mucosal
follicular hyperplasia and bronchial secretions increased with use of
bronchoscopy. Symptoms of subacute-stage SMPP were characterized by
decreased or normal fever peak, improved signs as assessed via lung
imaging, increased blood CRP, and decreased bronchial secretions and
airway blockages accompanied by mucous membrane necrosis and exfoliation
found via bronchoscopy. Symptoms of recovery-stage SMPP included normal
body temperature, normal blood CRP, and either improved findings via
lung imaging or atelectasis.
Bronchoscopic manifestations of acute-stage SMPP: all cases exhibited
different degrees of congestion and roughness of tracheal and bronchial
mucosa, mucosal longitudinal fold changes, and mucinous secretion.
During the first bronchoscopy, follicular hyperplasia of airway mucosa
was found in 162 cases (162/213, 76%), with lung lesions located in
grade I and grade II trachea. Erosion of airway mucosa was found in 105
cases (49.2%), with lesions located in grade III or lower grade
bronchi. Mucous plug blockages involving grade III or lower bronchi were
found in 47 cases (47/213, 22.0%). The mean disappearance time of
mucous plugs was 15 ± 1.7 days. The mean number of previous
bronchoscopies was 2.6 ± 3.5. Of cases with mucous plugs, 8 cases
(8/213, 3.8%) had severe mucous plug obstruction (with tree-like
bronchial-shaped changes). Locations of lesions were as follows: lesions
of 11 cases (11/213, 10.5%) were in the left upper lung, of 15 cases
were in the left lingual lobe (15/213, 14.3%), of 48 cases were in the
left lower basal segment (48/213, 45.7%), of 13 cases (13/213, 12.4%)
were in the right upper lobe, of 10 cases (10/213, 9.5%) were in the
right middle lobe, of 64 cases (64/213, 60.9%) were in the right lower
basal segment, of 63 cases (63/213, 60%) were in one lobe, of 32 cases
(32/213, 30.5%) were in two lobes, of 7 cases (7/213, 6.7%) were in
three lobes, of 3 cases (3/213, 2.8%) were in four lobes; no cases
involved five lobes.
Bronchoscopic manifestations in subacute and recovery stages: 22 cases
(22/213, 10.3%) had OB, including 13 males (13/22, 59%) and 9 females
(9/22, 41%). The median time to diagnosis of Sub-bronchial stenosis was
15 days [IQR 12-18]. The initial
obstruction was a thin film that was easily broken with biopsy forceps
in order to reopen the airway. With time, the untreated occluded airway
section gradually thickened and the center became concave and became
associated with a peripheral radial hyperplasia-like obstruction.
Proximal tracheal examination revealed the presence of fishbone-like
bronchiectases that were difficult to reopen using biopsy forceps
(Figures 1 and 2).