J Korean Med Sci.  2012 Sep;27(9):1114-1119. 10.3346/jkms.2012.27.9.1114.

Recurrent Plastic Bronchitis in a Child with 2009 Influenza A (H1N1) and Influenza B Virus Infection

• Kim S
• Cho HJ
• Han DK
• Choi YD
• Yang ES
• Cho YK
• Ma JS

• KMID: 1782149
• DOI: http://doi.org/10.3346/jkms.2012.27.9.1114

Abstract

Plastic bronchitis is an uncommon disorder characterized by the formation of bronchial casts. It is associated with congenital heart disease or pulmonary disease. In children with underlying conditions such as allergy or asthma, influenza can cause severe plastic bronchitis resulting in respiratory failure. A review of the literature showed nine cases of plastic bronchitis with H1N1 including this case. We report a case of a child with recurrent plastic bronchitis with eosinophilic cast associated with influenza B infection, who had recovered from plastic bronchitis associated with an influenza A (H1N1) virus infection 5 months previously. To the best of our knowledge, this is the first case of recurrent plastic bronchitis related to influenza viral infection. If patients with influenza virus infection manifest acute respiratory distress with total lung atelectasis, clinicians should consider plastic bronchitis and early bronchoscopy should be intervened. In addition, management for underlying disease may prevent from recurrence of plastic bronchitis.

Keyword

H1N1 Subtype Influenza A Virus; Influenza B virus; Bronchitis; Bronchial Hyperreactivity

MeSH Terms

Administration, Inhalation
Adrenal Cortex Hormones/therapeutic use
Antiviral Agents/therapeutic use
Bronchitis/complications/*diagnosis/drug therapy
Bronchoscopy
Child
DNA, Viral/analysis
Dyspnea/etiology
Humans
Hypersensitivity/pathology
Influenza A Virus, H1N1 Subtype/*genetics/isolation & purification
Influenza B virus/genetics/isolation & purification
Influenza, Human/complications/*diagnosis/drug therapy
Male
Oseltamivir/therapeutic use
Pulmonary Atelectasis/drug therapy/radiography
Real-Time Polymerase Chain Reaction
Tachypnea/etiology
Tomography, X-Ray Computed
Adrenal Cortex Hormones
Antiviral Agents
DNA, Viral
Oseltamivir

Figure

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  Fig. 1 Chest radiographs at the first attack with H1N1 infection in November, 2009 (A) and second attack with influenza B infection in April, 2010 (B) shows total atelectasis in the left lung and hyperaeration in the right lung.

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  Fig. 2 Chest computed tomography (CT) at the first attack (A, C) reveals left main bronchial obstruction with low attenuated materials and atelectasis of the left lung. Chest CT after bronchoscopic removal of bronchial casts (B, D) shows recovered left lung with good aeration.

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  Fig. 3 Casts extracted from the left main bronchus at the second attack showed preserved anatomy of the bronchial tree.

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  Fig. 4 The specimen composed of denudated bronchial epithelium, fibrin clot (black arrow), mucin material (white arrow), and inflammatory exudates. The inflammatory cells were eosinophils and neutrophils (H&E stain, × 200).

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