Primary bronchial fibrous histiocytoma mimicking refractory asthma in a child: A fatal case of misdiagnosis and airway obstruction.
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BACKGROUND: Primary tracheobronchial tumors in children are exceedingly rare and frequently mimic common pediatric respiratory conditions. Diagnostic delays often lead to critical airway obstruction, resulting in preventable morbidity and mortality. CASE PRESENTATION: A 4-year-old boy with a one-year history of chronic cough and recurrent wheezing was treated for "difficult-to-treat asthma" with systemic and inhaled corticosteroids without clinical remission. Following a mild viral infection, he presented with severe respiratory distress and hypoxemic failure. Despite endotracheal intubation, ventilation remained unsuccessful due to a fixed central airway obstruction. Emergent flexible bronchoscopy (FOB) revealed a fleshy, friable endoluminal mass in the right main bronchus, which was successfully removed. Histopathological and immunohistochemical analysis (CD68+, CD99+, SMA-focal, Desmin-) was most consistent with benign bronchial fibrous histiocytoma. Despite technically successful airway clearance, the patient suffered irreversible hypoxic-ischemic brain injury evidenced by diffuse cerebral edema on CT imaging and succumbed to the injury in the pediatric intensive care unit. CONCLUSION: Primary bronchial fibrous histiocytoma, though histologically benign, can cause fatal central airway obstruction in children. Persistent respiratory symptoms failing to respond to optimized asthma therapy should prompt early advanced imaging and bronchoscopic evaluation. Clinicians must maintain a high index of suspicion for structural airway disease to prevent catastrophic outcomes associated with delayed diagnosis and unrecognized fixed airway obstruction.