Management of Type 1 Plastic Bronchitis-A Pediatric Case Report

Plastic bronchitis (PB) is a rare and potentially fatal condition characterized by the formation of branching bronchial casts, leading to airway obstruction that can cause severe respiratory failure. We present the case of a 23-month-old male with a recent diagnosis of asthma who presented to our hospital with a worsening 7-day fever and a 5-day cough and shortness of breath. He had a history of two hospitalizations and multiple nebulizations with comparable symptoms before this appointment. His chest CT scan during his stay at our hospital revealed volume loss and consolidation with an air bronchogram in the lateral segment of the right middle lobe and the entire right lower lobe. Bronchoscopy showed that the bronchus intermedius was blocked by a bronchial mucus cast. After removal of the cast, the biopsy's histopathology revealed that the cast was made of fibrinous debris and inflammatory cells, predominantly eosinophils and a small number of neutrophils. As a result, this patient was given a working diagnosis of Type 1 plastic bronchitis. In treating this child's plastic bronchitis, our main objectives were to treat underlying problems, relieve acute airway obstructions, and stop further cast development. Bronchoalveolar culture revealed the growth of Klebsiella pneumoniae for which ceftazidime and avibactam were initiated. A follow-up chest X-ray showed a notable improvement. For both prevention and therapy, we started mucolytics and fibrinolytics for the patient. Montelukast, low-dose azithromycin, bronchodilators, and inhaled corticosteroids were employed to treat the inflammation resulting from his plastic bronchitis. A metered dose inhaler containing budesonide (Budecort) was given to the patient upon discharge to reduce inflammation and enhance lower lung airflow. The patient was given urgent pediatric follow-up on discharge to monitor symptom worsening/improvements. A high index of clinical suspicion is necessary for the diagnosis and management of plastic bronchitis (PB). Management entails ongoing medical care to address underlying diseases and avoid the need for additional casts, as well as the bronchoscopic removal of casts to relieve airway obstruction.