Post-RSV Bronchial Web Formation in a Lung Transplant Recipient: A Case Report

Bronchial webs (BW) are fibrinous membranes which obstruct the airway lumen. A 33-year-old female presented with acute lung allograft dysfunction following a recent respiratory syncytial virus (RSV) infection, having undergone bilateral lung transplant 2 years prior. Bronchoscopy identified subsegmental pale, translucent webs occluding six subsegments across both lung allografts. Each subsegment was dilated with an 8 mm balloon dilatation catheter. There was immediate symptomatic improvement without significant spirometric improvement. The described association between CLAD and BW may reflect an unusual airway complication of the bronchiolitis obliterans (BOS) CLAD phenotype, and the association with RSV infection suggests it has a possible role in the pathogenesis. This is in keeping with the paucity of data on this topic, where BW have been associated with BOS in patients with lung transplants and haematopoietic stem cell transplants. This is the first description of BW formation following RSV infection in a patient with CLAD, suggesting a pathophysiologic role of viral infection.