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A 9-year-old girl, on maintenance therapy for asthma, presented with 3 weeks of increasing dyspnoea. She had tachypnoea, hypoxaemia and bilateral crepitations on chest auscultation. Blood investigations revealed anaemia, leucocytosis and peripheral eosinophilia (table 1). Chest X-ray showed bilateral midzone infiltrates (figure 1A). A chest high-resolution CT (HRCT) scan performed after absence of clinical improvement with therapy, revealed bilateral central varicoid bronchiectasis, with tubular mucoid impaction in dilated bronchi in right lower lobe, called the ‘toothpaste sign’ (figure 2A).1 Within it is an area of higher …
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IIA and PV contributed equally.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.