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A1774 - Rare Case of Idiopathic Plastic Bronchitis in Adult
Author Block: M. M. Rachid1, P. Sharma1, A. Kumar1, M. Sunbuli1, E. Mekhaiel2; 1Internal Medicine, UIC/Advocate Christ Medical Center, Oak Lawn, IL, United States, 2UIC/Advocate Christ Medical Christ, Oak Lawn, IL, United States.
Introduction: Plastic bronchitis is a rare condition that affects pediatric patients after the Fontan procedure for congenital heart disease and is rarely associated with other pulmonary diseases. It is uncommon to see this disease in adults, especially without any suggestive medical history. Case report: A 21-year-old female with a past medical history of sinusitis and allergic rhinitis, presented with shortness of breath for a few weeks and sudden left sided chest pain. She had no history of bronchial asthma, congenital heart diseases or pulmonary diseases. Her vital signs were stable. Physical exam was remarkable for crackles and diminished breath sounds at the left lung base. Laboratory workup was unremarkable. Initial chest x-ray revealed left sided opacities. A Computed Tomography (CT) of the chest was obtained which demonstrated an occlusive mass on the left main bronchus. The patient underwent a flexible bronchoscopy which revealed a left main bronchus mass. Biopsies were negative for malignancy. Bronchoalveolar lavage showed acute inflammatory cells and was negative for fungal or mycobacterial infections. Rigid bronchoscopy was done, and the left main bronchus mass was removed. Pathology of the mass revealed inflammatory cells and mucus debris. The patient improved and was discharged home. The patient presented again with shortness of breath. CT chest revealed reappearance of obstructing left main bronchus mass. Bronchoscopy revealed mucus like lesion, fungating from the left lower lobe, with complete obstruction of the left main stem. The mass was removed by rigid bronchoscopy and pathology workup showed dense eosinophilic infiltrate and Charcot-Leyden crystals suggestive for plastic bronchitis. The patient was treated with steroids, mucolytics and nebulized hypertonic saline with remarkable improvement. Discussion: Plastic bronchitis is a rare condition of unclear mechanism characterized by the formation and deposition of rubbery thick casts in the bronchial airways. There are two classification systems to classify these bronchial casts based on histological findings and associated conditions. The patient usually presents with shortness of breath, productive cough, and rarely in acute respiratory failure. Chest x-rays and CT scans are helpful but not definitive in diagnosis. Almost every patient will need a bronchoscopy, either flexible or rigid, for mechanical removal of the bronchial casts. Management usually includes chest physical therapy, nebulized hypertonic saline, corticosteroids, bronchodilators and mucolytics. Few case reports suggested the use of aerosolized heparin and inhaled tissue-plasminogen activator (t-PA). We present this case with idiopathic plastic bronchitis to draw physicians’ attention to this rare entity.