Asthma-Related Plastic Bronchitis: A Challenging Diagnosis
Abstract
Plastic bronchitis (PB) is a rare but potentially life-threatening condition characterized by the formation of bronchial casts, leading to airway obstruction. It is associated with several underlying conditions, including congenital heart disease, respiratory infections, and asthma. Due to its non-specific symptoms, PB is often misdiagnosed or underdiagnosed. We present a case of a 10-year-old boy with a one-year history of recurrent productive cough, dyspnea, and fever, unresponsive to albuterol treatment. Chest X-rays revealed atelectasis of the left lower lung, which persisted despite airway clearance techniques. High-resolution computed tomography (HRCT) showed collapse consolidation of the left lung. Bronchoscopy revealed bronchial obstruction by a rubbery cast, which was successfully removed. Pathologic analysis of the cast showed eosinophils, neutrophils, and Charcot-Leyden crystals. The patient was treated with inhaled corticosteroids and short-acting beta-agonists, leading to complete resolution of symptoms. Follow-up after six months showed no recurrence of symptoms. This case highlights the importance of considering PB in patients with recurrent respiratory symptoms and atelectasis, particularly when foreign body aspiration or common respiratory diseases have been ruled out. Early diagnosis and management, including cast removal and treatment of underlying conditions, are crucial to preventing complications.
2. Larue M, Gossett JG, Stewart RD, Backer CL, Mavroudis CJacobs ML. Plastic bronchitis in patients with fontan physiology: review of the literature and preliminary experience with fontan conversion and cardiac transplantation. World J Pediatr Congenit Heart Surg. 2012;3(3):364-72.
3. Feray S, Mora P, Decavele M, Pham T, Hafiani EMFartoukh M. Plastic bronchitis: An unusual complication of acute chest syndrome in adult. Respir Med Case Rep. 2017;21:93-95.
4. Yuan L, Huang J-j, Zhu Q-g, Li M-zZhuo Z-q. Plastic bronchitis associated with adenovirus serotype 7 in children. BMC pediatrics. 2020;20:1-5.
5. Hussain HKherallah N. Eosinophilic lung disease with plastic bronchitis and bronchiectasis in an adolescent male. Clin Case Rep. 2018;6(12):2407-10.
6. Sheikh AY, Ahmadi-Kashani M, Mohindra V, Friedenberg A, Pramanik SBOgden WD. A Rare Case of Plastic Bronchitis in an Adult Patient After Cardiopulmonary Bypass. Ann Thorac Surg. 2016;101(3):1176-8.
7. Albitar HAHVassallo R, editors. Lymphatic plastic bronchitis secondary to thoracic duct stenosis. Mayo Clinic Proceedings; 2019: Elsevier.
8. Okada Y, Okada A, Narumiya H, Iiduka RKatsura K. Bloody bronchial cast formation due to alveolar hemorrhage associated with H1N1 influenza infection. Internal Medicine. 2017;56(20):2747-51.
9. Eberlein MH, Drummond MBHaponik EF. Plastic bronchitis: a management challenge. Am J Med Sci. 2008;335(2):163-9.
10. Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, et al. Current evaluation and management of plastic bronchitis in the pediatric population. Int J Pediatr Otorhinolaryngol. 2020;130:109799.
11. Brogan TV, Finn LS, Pyskaty DJ, Jr., Redding GJ, Ricker D, Inglis A, et al. Plastic bronchitis in children: a case series and review of the medical literature. Pediatr Pulmonol. 2002;34(6):482-7.
12. Cruz ATStarke JR. Pediatric tuberculosis. Pediatr Rev. 2010;31(1):13-25; quiz 25-6.
13. Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, et al. Diagnosis of cystic fibrosis: consensus guidelines from the Cystic Fibrosis Foundation. The Journal of pediatrics. 2017;181:S4-S15. e1.
14. Damseh N, Quercia N, Rumman N, Dell SDKim RH. Primary ciliary dyskinesia: mechanisms and management. Appl Clin Genet. 2017;10:67-74.
15. Mirra V, Werner CSantamaria F. Primary Ciliary Dyskinesia: An Update on Clinical Aspects, Genetics, Diagnosis, and Future Treatment Strategies. Front Pediatr. 2017;5:135.
16. Behan L, Dunn Galvin A, Rubbo B, Masefield S, Copeland F, Manion M, et al. Diagnosing primary ciliary dyskinesia: an international patient perspective. Eur Respir J. 2016;48(4):1096-107.
17. Manti S, Parisi GF, Papale M, Licari A, Chiappini E, Mule E, et al. Allergic bronchopulmonary aspergillosis in children. Pediatr Allergy Immunol. 2020;31 Suppl 26:20-22.
18. Eralp EE, Gokdemir Y, Atag E, Ikizoglu NB, Ergenekon P, Yegit CY, et al. Changing clinical characteristics of non-cystic fibrosis bronchiectasis in children. BMC Pulm Med. 2020;20(1):172.
19. Brower KS, Del Vecchio MTAronoff SC. The etiologies of non-CF bronchiectasis in childhood: a systematic review of 989 subjects. BMC pediatrics. 2014;14(1):1-8.
20. Chang AB, Bush AGrimwood K. Bronchiectasis in children: diagnosis and treatment. The lancet. 2018;392(10150):866-79.
21. Mohammad M, Saleem M, Mahseeri M, Alabdallat I, Alomari A, Za'atreh A, et al. Foreign body aspiration in children: A study of children who lived or died following aspiration. Int J Pediatr Otorhinolaryngol. 2017;98:29-31.
22. Jasinovic T, Kozak FK, Moxham JP, Chilvers M, Wensley D, Seear M, et al. Casting a look at pediatric plastic bronchitis. International journal of pediatric otorhinolaryngology. 2015;79(10):1658-61.
23. Madsen P, Shah SARubin BK. Plastic bronchitis: new insights and a classification scheme. Paediatr Respir Rev. 2005;6(4):292-300.
24. Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, et al. Current evaluation and management of plastic bronchitis in the pediatric population. International journal of pediatric otorhinolaryngology. 2020;130:109799.
25. Xiong L, Rao X, Peng X, Zhang GLiu H. Management of Plastic Bronchitis Using α-Chymotrypsin: A Novel Treatment Modality. Cureus. 2021;13(2).
26. Onoue Y, Adachi Y, Ichida FMiyawaki T. Effective use of corticosteroid in a child with life-threatening plastic bronchitis after Fontan operation. Pediatr Int. 2003;45(1):107-9.
| Files | ||
| Issue | Vol 6, No 4 (2023) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/igj.v6i4.17102 | |
| Keywords | ||
| Plastic Bronchitis Infections Asthma Respiratory Diseases | ||
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