Pediatr Infect Vaccine.  2018 Aug;25(2):101-106. 10.14776/piv.2018.25.e4.

A Case of Plastic Bronchitis Associated Influenza A Pneumonia Requiring ECMO Assistance

Affiliations
  • 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, the Republic of Korea. jdparkmd@snu.ac.kr
  • 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, the Republic of Korea.

Abstract

A 6-year-old boy with underlying hemolytic anemia of unknown etiology, atopic dermatitis, and recurrent urticaria visited our hospital because of acute respiratory failure induced by influenza A. Despite mechanical ventilation after endotracheal intubation along with inhalation of nitric oxide, respiratory acidosis and hypoxemia persisted. Veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion was performed to provide respiratory support. After performing flexible bronchoscopy, we found that thick mucus plugs were obstructing the right bronchus intermedius and the upper lobe orifice. After bronchial washing and removal of the plugs, we were able to wean the patient off VV ECMO and transfer him to the general ward. He was discharged without any neurologic or pulmonary sequelae.

Keyword

Bronchitis; Mucus; Influenza A virus; Extracorporeal membrane oxygenation; Bronchoscopy

MeSH Terms

Acidosis, Respiratory
Anemia, Hemolytic
Anoxia
Bronchi
Bronchitis*
Bronchoscopy
Child
Dermatitis, Atopic
Extracorporeal Membrane Oxygenation*
Humans
Influenza A virus
Influenza, Human*
Inhalation
Intubation, Intratracheal
Male
Mucus
Nitric Oxide
Patients' Rooms
Plastics*
Pneumonia*
Respiration, Artificial
Respiratory Insufficiency
Urticaria
Nitric Oxide
Plastics

Figure

  • Fig. 1 (A) Initial status of plastic bronchitis; initial chest radiograph showed that the 6-year-old patient's right lung was totally collapsed. (B) Status of plastic bronchitis after bronchoalveolar lavage; after removal of the thick mucus plugs, the right lung could be ventilated, and the tracheal deviation decreased. Infiltration of the left lower lung was present.

  • Fig. 2 (A) Findings of flexible bronchoscopy; yellowish and thick mucus plugs were observed at the opening of the right main bronchus. (B) Removal of thick mucus using flexible bronchoscopy; the size of mucus plugs was about 3.5 cm.

  • Fig. 3 Oxygenation index graph status during the days of hospital stay. Abbreviations: ECMO, extracorporeal membrane oxygenation; HD, hospital day.


Reference

1. Oliver T. Remarks on plastic or croupous bronchitis. BMJ. 1899; 2:69–72.
Article
2. Werkhaven J, Holinger LD. Bronchial casts in children. Ann Otol Rhinol Laryngol. 1987; 96:86–92.
Article
3. Rubin BK. Plastic bronchitis. Clin Chest Med. 2016; 37:405–408.
Article
4. Panchabhai TS, Mukhopadhyay S, Sehgal S, Bandyopadhyay D, Erzurum SC, Mehta AC. Plugs of the air passages: a clinicopathologic review. Chest. 2016; 150:1141–1157.
5. Eberlein MH, Drummond MB, Haponik EF. Plastic bronchitis: a management challenge. Am J Med Sci. 2008; 335:163–169.
Article
6. Ding XF, Zhong LL, Zhang B, Lin L, Huang H, Liang M. Clinical features and pathogens of plastic bronchitis in children: an analysis of 9 cases. Zhongguo Dang Dai Er Ke Za Zhi. 2014; 16:729–733.
7. Colt HG, Matsuo T. Hospital charges attributable to bronchoscopy-related complications in outpatients. Respiration. 2001; 68:67–72.
Article
8. Frobert E, Sarret C, Billaud G, Gillet Y, Escuret V, Floret D, et al. Pediatric neurological complications associated with the A(H1N1)pdm09 influenza infection. J Clin Virol. 2011; 52:307–313.
Article
9. Kim S, Cho HJ, Han DK, Choi YD, Yang ES, Cho YK, et al. Recurrent plastic bronchitis in a child with 2009 influenza A (H1N1) and influenza B virus infection. J Korean Med Sci. 2012; 27:1114–1119.
Article
10. Nogan SJ, Cass ND, Wiet GJ, Ruda JM. Plastic bronchitis arising from solitary influenza B infection: a report of two cases in children. Int J Pediatr Otorhinolaryngol. 2015; 79:1140–1144.
Article
11. Zhang J, Kang X. Plastic bronchitis associated with influenza virus infection in children: a report on 14 cases. Int J Pediatr Otorhinolaryngol. 2015; 79:481–486.
Article
12. Turgut T, In E, Özercan IH, Kaplan M. A case of plastic bronchitis. Arch Iran Med. 2014; 17:589–590.
13. Soyer T, Yalcin Ş, Emiralioğlu N, Yilmaz EA, Soyer O, Orhan D, et al. Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children. J Pediatr Surg. 2016; 51:1640–1643.
Article
14. Ugaki S, Lord DJ, Sherwood MC, Winlaw DS. Lymphangiography is a diagnostic and therapeutic intervention for patients with plastic bronchitis after the Fontan operation. J Thorac Cardiovasc Surg. 2016; 152:e47–e49.
Article
15. Hess NR, Piercecchi C, Desai N, Fisher MR, Lee EH, Force SD. Successful thoracic duct ligation for plastic bronchitis in an adult. Ann Thorac Surg. 2017; 103:e539–e540.
Article
16. Garcia-Henriquez N, Toloza EM, Khalil F, Echavarria MF, Garrett JR, Moodie CC, et al. Extensive plastic bronchitis: etiology of a rare condition. J Thorac Dis. 2016; 8:E961–E965.
Article
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