The Management of Influenza Virus-Induced Plastic Bronchitis in Pediatric Patients: A Case Report and Literature Review

Abstract

Although the incidence is very rare, plastic bronchitis (PB) could be a serious comorbid disease of virus infection in children, especially in those who have a history of bronchial asthma. We have recently experienced an influenza virus-induced PB who was successfully treated by endoscopic intervention under multidisciplinary approach in our institution. The purpose of this report is to confirm the role of otolaryngologists in the management of potentially lethal pediatric PB. A 7-year-old girl visited our institution (Kyorin University Hospital) and was hospitalized to the Pediatrics Department with worsening cough and chest pain. Chest radiography and computed tomography imaging showed a complete atelectasis of the left lung. Influenza virus testing proved the infection of influenza A in this patient, and she was treated by antiviral medication (peramivir hydrate), systemic steroid therapy and respiratory rehabilitation. However, her symptoms were worsening, and she was consulted to our department. Multiple clinical information suggested PB, and bronchoscopic evaluation/treatment was performed under general anesthesia using laryngeal mask 4 days after her hospitalization. Endoscopic intervention visualized the blockage of left main bronchus with highly viscous mucous, and her symptoms were improved by endoscopic suctioning of the mucus; and it was found that the inflammatory cells were eosinophil. Her pulmonary condition got better immediately after suctioning, and she was discharged 10 days after the intervention. Our report suggested the indispensable role of otolaryngologist for successful diagnosis and treatment of the influenza virus-induced PB in pediatric patients. Int J Clin Pediatr. 2022;11(1):20-26 doi: https://doi.org/10.14740/ijcp476