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Fatal plastic bronchitis with eosinophilic casts in a previously healthy child

Korean Journal of Pediatrics 2009;52(9):1048-1052.
Published online September 15, 2009.
Fatal plastic bronchitis with eosinophilic casts in a previously healthy child
Young Kuk Cho, Soo Min Oh, Woo-Yeon Choi, Eun Song Song, Dong-Kyun Han, Young-Ok Kim, Jae Sook Ma
Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
건강하였던 소아에서 발생한 치명적인 호산구성 증식성 기관지염
조영국, 오수민, 최우연, 송은송, 한동균, 김영옥, 마재숙
전남대학교 의과대학 소아과학교실, 전남대학교병원 소아청소년과
Jae Sook Ma, Email: cardiol@jnu.ac.kr
Plastic bronchitis is a rare disease characterized by the recurrent formation of branching mucoid bronchial casts that are large and more cohesive than those that occur in ordinary mucus plugging. Casts may vary in size and can be spontaneously expectorated, but some require bronchoscopy for removal. Plastic bronchitis can therefore present as an acute life-threatening emergency if obstruction of the major airways occurs. Three of 22 reported patients with eosinophilic casts were fatal, with death due to central airway obstruction. Here, we report a child with no history of atopy, allergy, or congenital heart disease who was diagnosed with plastic bronchitis with eosinophilic casts. Although he was administered intravenous (iv) antibiotics; iv corticosteroids; and a vigorous pulmonary toilet regimen, including chest physiotherapy and routine bronchoscopic removal of casts, he had brain death secondary to hypoxic brain damage. Plastic bronchitis can be fatal when casts obstruct the major airways, as in the present case. Clinicians should intervene early if a patient exhibits signs and symptoms consistent with plastic bronchitis.
Key Words: Plastic bronchitis, Cast bronchitis, Airway obstruction, Eosinophilic cast

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