Let´s Look further: “Not everything is athsma” Les´t talk about DIPNECH: a case report

Abstract

Background: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare entity considered a pre-invasive lesión within the spectrum of neuroendocrine tumors. It´s pathophysiology involves chronic inflamamatory injury to the respiratory epithelium that leads to smooth muscle hypertrophy, and nodular cell proliferation.

Objectives: This paper reviews the main characteristics of this pathology and highlights the importance of reconsidering the diagnosis in cases of treatment failure in severe asthma.

Key words: diffuse neuroendocrine cell hyperplasia, carcinoid tumor, asthma,

Case report: We present the case of a 61 –year-old patient under follow-up for diagnosis of severe asthma, who, after six months of biological treatment whith Mepolizumab and optimal inhaled theraphy, remained symptomatic.

Results: In the diagnostic re-evaluation, the computed tomography of the chest revealed multiple nodules, which did not show pathological uptake on the 18F- FDG PET-TC. Following  discussion in a muntidisciplinary meering, a confirmatory lung biopsy for DIPNECH was performed. tomography,histopatology.