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Published on: February 22, 2019
Case Report: Plastic bronchitis temporally associated with bordetella pertussis infection in a vaccinated child
Haiting Lin1, Mingfei Zhong1, Yuan Tu1
1Department of Pediatrics, The People's Hospital of Cenxi City, Wuzhou, Guangxi, China.
Insights
This case report details plastic bronchitis (PB) in a vaccinated child with Bordetella pertussis infection. Early bronchoscopy is recommended for persistent pneumonia with atelectasis.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Case Reports
Background:
- Plastic bronchitis (PB) is a rare condition characterized by the formation of obstructive mucopurulent casts in the airways.
- While often associated with conditions like cyanotic heart disease or post-operative states, its association with infectious agents, particularly in vaccinated individuals, is less understood.
Objective:
To describe the clinical presentation, diagnostic process, management, and potential mechanisms of plastic bronchitis (PB) temporally associated with Bordetella pertussis infection in a vaccinated child.
Methods:
This case report follows the CARE (Case Report) guidelines. We describe the clinical course of a 6-year-old boy with PB complicating lower respiratory tract infection, including clinical features, laboratory findings, imaging, bronchoscopy, bronchoalveolar lavage fluid (BALF) pathogen detection, treatment, and follow-up.
Results:
The patient presented with a 4-day history of cough and fever without the classical inspiratory "whoop" of pertussis. He had completed routine pertussis immunization. Chest computed tomography (CT) demonstrated right middle lobe atelectasis with bilateral pulmonary inflammation. Despite symptomatic improvement following empirical antimicrobial therapy, atelectasis persisted. Flexible bronchoscopy revealed obstructive mucopurulent airway casts consistent with PB, which were removed. BALF pathogen detection identified Bordetella pertussis and Rhinovirus A as high-confidence pathogens, with Aspergillus fumigatus and Epstein-Barr virus detected at lower confidence levels. After bronchoscopic intervention and pathogen-directed therapy, symptoms resolved completely and imaging confirmed lung re-expansion. No recurrence was observed during 6 months of follow-up.
Conclusion:
This case reports a potential temporal association between PB and Bordetella pertussis infection in a vaccinated child with atypical clinical features. To our knowledge, this is the first documented case of PB temporally associated with B. pertussis. However, causality cannot be definitively established due to the presence of copathogens and the low sequence count of the bacterium. Early bronchoscopy with BALF analysis should be considered in children with pneumonia complicated by persistent atelectasis or poor response to empirical therapy.
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