Management of Type 1 Plastic Bronchitis-A Pediatric Case Report

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Critical Care

Background:

• Plastic bronchitis (PB) is a rare, life-threatening condition characterized by bronchial cast formation causing airway obstruction and respiratory failure.
• Asthma diagnosis in a 23-month-old male preceded symptoms of fever, cough, and shortness of breath, indicating a complex respiratory presentation.

Purpose of the Study:

• To present a case of Type 1 plastic bronchitis in a pediatric patient.
• To outline the diagnostic and management strategies for pediatric plastic bronchitis.

Main Methods:

• Diagnostic bronchoscopy revealed a bronchial mucus cast obstructing the bronchus intermedius.
• Histopathology confirmed the cast composed of fibrinous debris and inflammatory cells, predominantly eosinophils.
• Treatment involved cast removal, antibiotics (ceftazidime/avibactam) for Klebsiella pneumoniae, mucolytics, fibrinolytics, and anti-inflammatory medications.

Main Results:

• Bronchoscopic removal of the cast relieved acute airway obstruction.
• Antibiotic therapy targeted the identified Klebsiella pneumoniae infection.
• A combination of medical therapies improved the patient's respiratory status, as evidenced by follow-up chest X-ray.

Conclusions:

• A high index of clinical suspicion is crucial for diagnosing and managing plastic bronchitis.
• Effective management requires addressing underlying conditions, relieving airway obstruction, and preventing cast recurrence.