Plastic bronchitis secondary to bocavirus in a previously healthy 4-year-old with negative lymphatic evaluation

Area of Science:

• Pediatric Pulmonology
• Rare Diseases
• Infectious Diseases

Background:

• Plastic bronchitis (PB) is a rare but serious condition characterized by the formation of proteinaceous casts in the bronchial tree.
• Etiology of PB is often unclear, posing diagnostic and therapeutic challenges, particularly in pediatric patients.

Observation:

• A case of severe acute respiratory failure in a child requiring extracorporeal membrane oxygenation due to plastic bronchitis is presented.
• The child had no known underlying inflammatory or lymphatic conditions.
• Lymphatic anatomy and flow appeared normal weeks after the acute illness, suggesting a transient abnormality.

Findings:

• The acute lower respiratory tract infection with human bocavirus-1 (HBoV1) is implicated as a potential trigger for transient lymphatic flow abnormalities.
• Four pediatric cases of PB associated with HBoV1 are now documented in the literature.
• HBoV1 may be a contributing factor in the etiology of plastic bronchitis of unknown origin.

Implications:

• HBoV1 should be considered in the workup for pediatric patients presenting with unexplained plastic bronchitis.
• Further investigation into the pathophysiology of PB, potentially including advanced imaging like MR lymphangiography in acute settings, is warranted.
• Understanding the complex pathophysiology is crucial for guiding management and improving prognosis in patients with plastic bronchitis.