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Plastic bronchitis due to adenoviral infection: a case report
Fei Zhou Zhang1, Lu Qin1, Jie Xin Yuan1
1Zhejiang University School of Medicine of Children's Hospital, 3333 Binsheng Road, Hangzhou, 310051, China.
Insights
Plastic bronchitis (PB) is a serious complication after the Fontan procedure. This case highlights adenoviral infection as a cause of PB in children, emphasizing early diagnosis and intervention.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Plastic bronchitis (PB) is a known complication following the Fontan procedure.
- The exact causes of PB remain largely unknown.
- This study focuses on a pediatric case of PB.
Observation:
- A 4-year-old girl presented with persistent cough and fever.
- Respiratory failure necessitated extracorporeal membrane oxygenation.
- Bronchial dendritic casts were removed via flexible bronchoscopy, leading to improved breathing.
Findings:
- Pathological examination confirmed type I plastic bronchitis.
- Adenoviral infection, specifically human adenovirus 7, was identified as the cause.
- Next-generation sequencing confirmed the presence of adenovirus in bronchoalveolar lavage fluid.
Implications:
- Human adenovirus 7 infection should be considered in pediatric cases of persistent respiratory failure.
- Early flexible bronchoscopy is crucial for diagnosing PB and removing airway obstructions.
- Prompt diagnosis and treatment can lead to favorable outcomes in children with PB.
Background:
Plastic bronchitis (PB) frequently occurs as a serious postoperative complication of the Fontan procedure. The definitive causes of PB are unknown.
Case Presentation:
Herein, we report a pediatric case of PB secondary to adenoviral infection. A 4-year-old girl was admitted to the general pediatric ward for cough since 2 weeks and fever since 11 days. Consolidated lesions were noted in the right upper and both lower lung lobes. Extracorporeal membrane oxygenation was performed because the patient's respiratory failure remained unalleviated despite the use of a ventilator. Bronchial dendritic casts were extracted using flexible bronchoscopy, and the patient's breathing improved. Pathological examination of the dendritic cast confirmed the diagnosis of type I PB. The exfoliated cells of sputum and cells from bronchoalveolar lavage fluid were positive for adenoviral antigen. Human adenovirus 7 was detected by next-generation sequencing of the bronchoalveolar lavage fluid. The patient recovered and was discharged 39 days after admission without recurrence of cough or wheezing.
Conclusions:
PB due to human adenovirus 7 infection should be considered in children with persistent respiratory failure. Flexible bronchoscopy should be performed early to confirm diagnosis and to remove any airway obstruction.
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