Enterovirus D68 infection causing plastic bronchitis and severe pneumonia: a case report and literature review

Plastic bronchitis (PB) is a rare disease characterized by the formation of tree-like or tubular mucus plugs within the bronchi, which can lead to severe airway obstruction and respiratory failure, potentially becoming life-threatening if diagnosis and treatment are delayed. Enterovirus D68 (EV-D68) is a common pathogen that causes acute respiratory infections in children,which can lead to wheezing, acute flaccid myelitis, and even respiratory failure. Nevertheless, a direct association between EV-D68 infection and plastic bronchitis has not been previously reported. As the first documented case, this report establishes the association between EV-D68 and plastic bronchitis, thereby expanding the clinical spectrum of EV-D68.

We report a case of plastic bronchitis and severe pneumonia caused by Enterovirus D68 infection. To identify additional cases and elucidate the clinical characteristics of this condition, a systematic literature search was conducted using PubMed, Embase, and Web of Science databases for the period from January 2006 to June 2026. The search strategy employed the following keywords: "Enterovirus D68" "plastic bronchitis" and "severe pneumonia".

This case involved an 11-year-old girl with previously good health. Chief complaints: cough and wheezing for 1 day, chest pain for half a day. Chest CT showed patchy increased-density opacities in the left upper loben with reduced left upper lobe volume, small nodular increased-density opacities in the left lower lobe and right lower lobe, right pleural thickening. Following admission, two flexible bronchoscopic examinations with plastic cast removal and bronchoalveolar lavage (BAL) were performed; bronchoscopic findings were consistent with plastic bronchitis and bronchial mucosal inflammation. Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid(BALF) detected Enterovirus D68 and Rhinovirus. Intravenous immunoglobulin support and methylprednisolone anti-inflammatory therapy were also administered. By hospital day 10, the patient's condition had stabilized;Follow-up chest CT demonstrated resolution of the left upper lobe patchy high-density opacities with re-expansion of the left upper lobe, patchy high-density opacities in the left lower lobe and small left pleural effusion. The newly developed lesion in the left lower lobe was considered resolving inflammatory changes rather than new active infection. The patient was discharged with medication. At 6 days post-discharge, follow-up chest CT demonstrated complete resolution of pulmonary infiltrates, pleural effusions, consistent with full clinical recovery. The total duration of treatment was 10 days of hospitalization plus 6 days of oral therapy after discharge, giving a total of 16 days.

EV-D68 infection should be recognized as a potential etiology of plastic bronchitis or severe pneumonia in children. In addition to direct pathogen-mediated tissue injury, immune-mediated damage warrants careful consideration in the underlying pathophysiological mechanisms. Early bronchoscopic intervention combined with anti-inflammatory and immunomodulatory therapy may prove critical in shortening the disease course and improving clinical outcomes.