All issues > Volume 52(9); 2009

Case Report

Korean J Pediatr. 2009;52(9):1048-1052. Published online September 15, 2009.

Fatal plastic bronchitis with eosinophilic casts in a previously healthy child

Young Kuk YK Cho¹, Soo Min SM Oh¹, Woo-Yeon WY Choi¹, Eun Song ES Song¹, Dong-Kyun DK Han¹, Young-Ok YO Kim¹, Jae Sook JS Ma¹

¹Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea

Correspondence Jae Sook JS Ma ,Email: cardiol@jnu.ac.kr

Abstract

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.

Keywords :Plastic bronchitis, Cast bronchitis, Airway obstruction, Eosinophilic cast