Swyer -James syndrome (SJS) is a rare, constrictive bronchiolitis characterized by a unilateral hyperlucent lung, resulting from an insult to the lower respiratory tract. 1 Typical symptoms include recurrent pulmonary infections, chronic cough, wheezing and exertional dyspnea. 2 Known etiologies include infection (particularly adenovirus and Mycoplasma pneumoniae ), 3 aspiration, and toxic inhalation. Although the clinical and radiologic features of measles pneumonia and its sequela have been described, 4 SJS, as a sequela of measles infection, has been rarely reported. 5, 6 We report a case of post-measles SJS with fi nger clubbing and pulmonary hypertension improved by surgery in a 5-year-old Korean boy.
Case reportA 5-year-old Korean boy was admitted to Department of Pediatrics, Inje University Sanggye Paik Hospital due to wheezing and exertional dyspnea with mild suprasternal retractions. At the age of 23 months he had been admitted to the intensive care unit of a local hospital for acute pneumonia with severe respiratory failure caused by measles during an outbreak that occurred in 2000 -2001, in Korea. After the episode of measles pneumonia he had a history of recurrent pulmonary infections with wheezing, exercise intolerance and blue discoloration of lips and nails. During the next 3 years he suffered from a progressive, decline in exercise tolerance. There was no family history of pulmonary tuberculosis and his living conditions were not unusual.On admission physical examination indicated obvious fi nger clubbing, pectus carinatum with mild suprasternal retractions, expiratory wheezes and rales in bilateral lower lung fi elds. Routine laboratory work-up was as follows: white blood count, 21 510 cells/mm 3 (cell differential: neutrophils, 74.2%; lymphocytes, 17.3%; monocytes, 5.4%); hemoglobin level, 12.2 g/dL; and normal serum electrolytes. Room-air, arterial blood gasses were PaO 2 , 50 mmHg; PaCO 2 , 53 mmHg; and pH 7.33. Sputum and blood cultures were negative for bacteria, fungi and viruses. Sputum smears tested negative for acid-fast bacilli.Chest X-ray showed total collapse with saccular bronchiectasis in the right lung and a left lung that was hyperlucent with decreased vascularity and air-trapping. Furthermore, there was herniation of the left upper lobe into the right hemithorax. Highresolution computed tomography (HRCT) demonstrated saccular bronchiectasis in the right lung and air-trapping in the left lung ( Fig. 1 ). The diameter of the left pulmonary artery was enlarged (12 -14.5 mm) while the right pulmonary artery diameter was decreased (12 -11 mm) on contrast enhanced CT scan, owing to compensatory hypertrophy of the left lung ( Fig. 2 ). These clinical and radiologic fi ndings suggested a diagnosis of SJS.Bronchoalveolar lavage (BAL) was performed by instilling 1 mL/kg saline solution into a segmental bronchus of the right middle lobe three times. The differential cell count in BAL fl uid indicated a signifi cant increase in neutrophils (21%macrophages, 13% lymphocytes, 60% neutrophils, ...
