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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 74-75

Autobullectomy: A rare case of spontaneous resolution of infected giant bullae


Department of Pulmonary Medicine, S.M.S. Medical College, Jaipur, Rajasthan, India

Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. Jitendra Kumar Sharma
Department of Pulmonary Medicine, S.M.S. Medical College, Jaipur 302016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacp.jacp_20_18

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  Abstract 

Introduction: Bullous lung disease is a common presentation in patients with chronic obstructive pulmonary disease (COPD). The giant pulmonary bulla occupies one third of involved hemithorax and characterized by the existence of centrilobular emphysema in non bullous lung. Sometimes air reabsorbs spontaneously leading to shrinkage and regression of bulla known as autobullectomy. Mechanism of autobullectomy remains unclear. Here, we report a patient with infected bulla who experienced complete resolution after antifungal treatment. Case History: A 63 year old mal with history of twenty pack years of tobacco smoking came to the pulmonary outpatient department with complains of left side chest pain, cough with mild expectoration and low grade fever since five days. Patient also had blood tinged sputum since three days. His chest X-Ray PA view showed a thin walled cavity with air fluid level on the left upper zone with a few calcified parenchymal foci. Patient had symptomatic improvement after two weeks of antifungal treatment. Repeat skiagram chest and CECT chest showed complete resolution of bulla. Discussion: There are two hypotheses which can explain occurrence of bulla: Conclusion: Spontaneous resolution of giant bulla also known as autobullectomy is an ignorant event and follows an infection trigger. The early suspicion and diagnosis by the treating physician can avert the need for a surgical bullectomy in these patients and decline the morbidity and mortality. Our case is of interest not only because of the rarity with which spontaneous regression has been reported in the literature but also because the source of infection was fungal.

Keywords: autobullectomy, antiprotease, emphysema, giant bulla, protease


How to cite this article:
Jain S, Joshi V, Sharma JK. Autobullectomy: A rare case of spontaneous resolution of infected giant bullae. J Assoc Chest Physicians 2019;7:74-5

How to cite this URL:
Jain S, Joshi V, Sharma JK. Autobullectomy: A rare case of spontaneous resolution of infected giant bullae. J Assoc Chest Physicians [serial online] 2019 [cited 2019 Jul 19];7:74-5. Available from: http://www.jacpjournal.org/text.asp?2019/7/2/74/260584


  Introduction Top


Bullous lung disease is a common presentation in patients with chronic obstructive pulmonary diseases (COPD). The giant pulmonary bulla occupies one third of involved hemithorax and is characterized by the existence of centrilobular emphysema in nonbullous lung. Sometimes air reabsorbs spontaneously leading to shrinkage and regression of bullae, known as autobullectomy. Mechanism of autobullectomy remains unclear. Here, we report a patient with infected bullae who experienced complete resolution after antifungal treatment.


  Case History Top


A 63-year-old male with history of 20 pack-years of tobacco smoking came to the pulmonary outpatient department with complaints of left side chest pain, cough with mild expectoration, and low-grade fever since 5 days. Patient also had blood-tinged sputum for 3 days. His chest X-ray posteroanterior (PA) view showed a thin-walled cavity with air fluid level on the left upper zone with a few calcified parenchymal foci. Patient had symptomatic improvement after 2 weeks. Repeat skiagram chest and contrast-enhanced computed tomography (CECT) chest showed complete resolution of bulla.


  Discussion Top


There are two hypotheses that can explain occurrence of bulla:

First, it has been assumed that smoking inflame the subcellular inflammatory mediators that let down the balance in alveolar proteases and antiproteases, triggering a chain reaction at the cellular level that sooner or later hints to destruction of alveolar walls.

Second, oxidative stress results from an imbalance between oxidant and antioxidant proteins causing destruction of lung parenchyma.


  Conclusion Top


Spontaneous resolution of giant bullae, also known as autobullectomy, is an ignorant event and follows an infectious trigger. The early suspicion and diagnosis by the treating physician can avert the need for a surgical bullectomy in these patients and decline the morbidity and mortality. Our case is of interest not only because of the rarity with which spontaneous regression has been reported in the literature but also because the source of infection was fungal.






 

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