Zhejiang University School of Medicine of Children's Hospital, 3333 Binsheng Road, Hangzhou, 310051, China.
BMC Pediatr. 2020 Feb 10;20(1):61. doi: 10.1186/s12887-020-1954-0.
Plastic bronchitis (PB) frequently occurs as a serious postoperative complication of the Fontan procedure. The definitive causes of PB are unknown.
Herein, we report a pediatric case of PB secondary to adenoviral infection. A 4-year-old girl was admitted to the general pediatric ward for cough since 2 weeks and fever since 11 days. Consolidated lesions were noted in the right upper and both lower lung lobes. Extracorporeal membrane oxygenation was performed because the patient's respiratory failure remained unalleviated despite the use of a ventilator. Bronchial dendritic casts were extracted using flexible bronchoscopy, and the patient's breathing improved. Pathological examination of the dendritic cast confirmed the diagnosis of type I PB. The exfoliated cells of sputum and cells from bronchoalveolar lavage fluid were positive for adenoviral antigen. Human adenovirus 7 was detected by next-generation sequencing of the bronchoalveolar lavage fluid. The patient recovered and was discharged 39 days after admission without recurrence of cough or wheezing.
PB due to human adenovirus 7 infection should be considered in children with persistent respiratory failure. Flexible bronchoscopy should be performed early to confirm diagnosis and to remove any airway obstruction.
塑料支气管病（PB）常作为 Fontan 手术后的严重术后并发症发生。PB 的明确病因尚不清楚。
在此，我们报告一例继发于腺病毒感染的儿童 PB 病例。一名 4 岁女孩因咳嗽 2 周和发热 11 天入住普通儿科病房。右肺上叶和双下肺叶均可见实变病灶。尽管使用了呼吸机，但患者的呼吸衰竭仍未缓解，因此进行了体外膜氧合。使用软性支气管镜取出了支气管树突状铸型，患者呼吸状况得到改善。树突状铸型的病理检查证实了 I 型 PB 的诊断。痰脱落细胞和支气管肺泡灌洗液中的细胞腺病毒抗原阳性。通过对支气管肺泡灌洗液进行下一代测序检测到人类腺病毒 7 型。患者在入院后 39 天康复出院，无咳嗽或喘息复发。
对于持续存在呼吸衰竭的儿童，应考虑人腺病毒 7 感染引起的 PB。应尽早进行软性支气管镜检查以明确诊断并清除任何气道阻塞。
