Plastic Bronchitis in a 5-year-old Boy Causing Asystoly and Fatal Outcome

Author: Bongaerts Dries   Wojciechowski Marek   Suys Bert   Luijks Marloes   Van Marck Eric   Jorens Philippe  

Publisher: Informa Healthcare

ISSN: 0277-0903

Source: Journal of Asthma, Vol.46, Iss.6, 2009-08, pp. : 586-590

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Abstract

Here we present the case of a 5-year-old boy who experienced a prehospital cardiac arrest after a period of wheezing, upper respiratory tract infection, and diarrhea. After successful resuscitation, ventilation was initially extremely difficult for no obvious reason. Various bronchodilatatory therapies were started with only limited result. Diagnosis of plastic bronchitis was made after bronchoscopy and at autopsy when therapy was withdrawn in view of the absence of cerebral circulation. A thickened basal membrane, a specific hallmark of asthma, was also present. Cardiac arrest in plastic bronchitis due to inflammatory and allergic disease is very rare. Pathological examination of the cast showed a mucinous cast with neutrophilic granulocytes, which is also seldom seen. This case illustrates that the diagnosis of plastic bronchitis can be extremely difficult if only minor respiratory symptoms occur. This resulted in a delayed diagnosis and fatal outcome.