Plastic bronchitis in three children associated with 2009 influenza A(H1N1) virus infection

Plastic bronchitis is an uncommon disorder generally associated with congenital heart disease or sickle cell acute chest syndrome. During the winter outbreak of 2009 influenza A(H1N1) [influenza A(H1N1)] virus infection, we cared for three children who developed plastic bronchitis without the typical underlying conditions. The diagnosis of plastic bronchitis was made using flexible bronchoscopy and was confirmed by histopathology. These children had influenza-like illness, and the assay for influenza A(H1N1) virus was positive in their nasopharyngeal swab and BAL fluid. The chest imaging showed consolidation or atelectasis. After bronchoscopic extraction of casts and antiviral treatment, all of the patients recovered, and there has been no recurrence of the plastic bronchitis. Infection with influenza A(H1N1) is known to cause inflammation and decreased mucociliary clearance, and this may place some patients, especially children, at risk for airway obstruction.