Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: An Uncommon Clinical Challenge.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare interstitial lung disease characterized by diffuse proliferation of neuroendocrine cells in the airway mucosa and regarded as a preneoplastic condition. It typically affects nonsmoking middle-aged or elderly women and often presents with insidious symptoms like chronic cough, exertional dyspnea, and wheezing. Since these non-specific features may resemble asthma or other obstructive pulmonary airway diseases, the diagnosis is frequently challenging and therefore delayed. Chest high-resolution computed tomography (HRCT) typically shows multiple small pulmonary nodules and a mosaic attenuation pattern, but histological analysis, most reliably obtained by video-assisted thoracoscopic surgery (VATS) biopsy, is the key to establishing the diagnosis. Herein, we report the case of an elderly woman with a 12-year history of productive cough, exertional dyspnea, and wheezing, initially misdiagnosed as chronic obstructive pulmonary disease (COPD). HRCT revealed multiple small solid nodules and a mosaic attenuation pattern. On physical examination, basal crackles and squeaks were noted on lung auscultation. Following persistent symptoms and inconclusive noninvasive investigations, a VATS lung biopsy was performed, which established the diagnosis of DIPNECH. The patient was treated with systemic corticosteroids and long-acting bronchodilators but developed steroid-related complications without clinical improvement. Follow-up