J Korean Med Sci.  2022 Aug;37(31):e246. 10.3346/jkms.2022.37.e246.

A Case Report of Postinfectious Bronchiolitis Obliterans After Coronavirus Disease 2019 in a 10-YearOld Child

Affiliations
  • 1Department of Pediatrics, Division of Pediatric Allergy and Respiratory Diseases, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea
  • 2Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea
  • 3Department of Pediatrics, Division of Pediatric Infectious Diseases, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea

Abstract

Coronavirus disease 2019 (COVID-19) is usually less severe in children and adolescents than in adults. However, it can cause severe respiratory illness in a small proportion of children with risk factors. Here, we report a rare case of a 10-year-old boy with postinfectious bronchiolitis obliterans that developed after pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This patient was previously healthy apart from a high body mass index (BMI, 30.13; 99.6th percentile for the age bracket), history of preterm birth (35 weeks), and low birth weight (1,850 g). He had persistent exertional dyspnea after recovering from SARS-CoV-2-related pneumonia. Spirometry revealed obstructive lung disease with the following results: predicted forced vital capacity (FVC% pred ), 71%; forced expiratory volume in 1 second (FEV 1 % pred ), 63%; FEV 1 /FVC, 0.81; and forced expiratory flow 25-75 % pred , 55%. Chest computed tomography showed multifocal areas of parenchymal hyperlucency and mosaic attenuation in both lungs. This case suggests that careful observation of children with obesity and low birth weight is necessary after recovery from SARS-CoV-2-related pneumonia.

Keyword

COVID-19; Bronchiolitis Obliterans; Children; Pediatrics; Obesity; Low Birth Weight

Figure

  • Fig. 1 Timeline of clinical course and treatment.HHFNC = humidified high flow nasal cannula, FiO2 = fraction of inspired oxygen.

  • Fig. 2 Serial chest radiographs. (A) HD 1: Chest PA on January 3, 2022, showed bilateral patchy, confluent, ground-glass opacity and consolidation in the mid to lower lung zones. (B) HD 3: Chest AP on January 5, 2022, showed increased extent of the diffuse bilateral opacities and consolidation in the left lower lung field. (C) HD 8: Chest AP on January 10, 2022, showed decreased bilateral opacities and consolidation. (D) At the outpatient clinic: Chest PA on January 27, 2022, showed radiographic improvement.HD = hospital day, AP = anteroposterior, PA = posteroanterior.

  • Fig. 3 Pulmonary function test at the time of PIBO diagnosis.PIBO = postinfectious bronchiolitis obliterans, FVC = forced vital capacity, FEV1 = forced expiratory volume in 1 second, FEF = forced expiratory flow, PEF = peak expiratory flow, FET = forced expiratory time, FIVC = forced inspiratory vital capacity, FIV = forced inspiratory vital, MVV = maximum voluntary ventilation, ECode = error code, Vol Extrap = volume extrapolating, BTPS = body temperature and pressure saturated, pred = predicted.

  • Fig. 4 Chest CT images at the time of postinfectious bronchiolitis obliterans diagnosis. Axial high-resolution CT images captured on February 18, 2022, showed parenchymal hyperlucency and mosaic attenuation in both lungs.


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