Severe Asthma Attack-associated Middle Lobe Syndrome in an Uncontrolled Asthma Patient

Middle lobe syndrome is a well-defined clinical and radiological entity in the pediatric literature, The causes include many pathologies such as asthma, lymphadenopathy, tumor, foreign body aspiration, granulation tissue, mucus plug, bronchopulmonary dysplasia, and cystic fibrosis. A nine-year-old girl with a diagnosis of asthma, who lack regular follow-up visits and a regular treatment, was admitted to the pediatric emergency department with respiratory distress. On physical examination; tachipnea, dyspnea, bilateral wheezing was revealed. Oxygen saturation was 80% in room air. Chest X-ray showed atelectasis in the right middle lobe and bilateral pneumonic infiltrates, more prominently in the right lung. The patient was started a non-invasive mechanical ventilation support, a broad-spectrum antibiotic therapy, asthma medication, N-acetylcysteine nebule therapy and chest physiotherapy. The chest X-ray showed improvement in atelectasis on the 5th day of treatment. Middle lobe syndrome has a very good prognosis when diagnosed early and treated appropriately. It should be kept in mind in patients with recurrent or persistent respiratory symptoms. Asthma is one of the most common causes of middle lobe syndrome in children, and uncontrolled asthma patients constitute a high risk. It is very important for asthma patients to continue their regular follow-up and to receive appropriate treatment according to their disease control.