Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, Shenzhen, 518026, Guangdong, China.
BMC Pediatr. 2023 Oct 17;23(1):517. doi: 10.1186/s12887-023-04351-0.
The etiology of Plastic bronchitis (PB) is unknown. The incidence of pulmonary infection associated with PB has increased year by year, but respiratory syncytial virus (RSV) as a pathogen causes PB has rarely been reported.
A 2-year-old immunocompromised girl was admitted to the hospital with cough, fever for 5 days, and aggravated with shortness of breath for 1 day. With mechanical ventilation, her respiratory failure was not relieved, and subcutaneous emphysema and mediastinal pneumatosis appeared. Extracorporeal membrane oxygenation (ECMO) was administrated, but the tidal volume was low. Therefore, a bronchoscopy was performed, by which plastic secretions were found and removed. Pathology of the plastic secretions confirmed the diagnosis of type I PB. RSV was the only positive pathogen in the alveolar lavage fluid by the next-generation sequencing test. After the bronchoscopic procedure, her dyspnea improved. The patient was discharged with a high-flow nasal cannula, with a pulse oxygen saturation above 95%. Half a year after discharge, she developed sequelae of bronchitis obliterans.
RSV could be an etiology of PB, especially in an immunocompromised child. In a patient with pulmonary infection, if hypoxemia is presented and unresponded to mechanical ventilation, even ECMO, PB should be considered, and bronchoscopy should be performed as soon as possible to confirm the diagnosis and to treat.
塑料性支气管炎（PB）的病因尚不清楚。与 PB 相关的肺部感染发病率逐年增加，但作为病原体的呼吸道合胞病毒（RSV）引起 PB 的情况很少见报道。
一名 2 岁免疫功能低下的女孩因咳嗽、发热 5 天，呼吸困难加重 1 天入院。虽然接受了机械通气，但她的呼吸衰竭并未得到缓解，出现皮下气肿和纵隔积气。给予体外膜氧合（ECMO）治疗，但潮气量较低。因此，进行了支气管镜检查，发现并清除了塑料分泌物。塑料分泌物的病理检查证实了 I 型 PB 的诊断。下一代测序试验显示，肺泡灌洗液中只有 RSV 是阳性病原体。支气管镜检查后，她的呼吸困难得到改善。患者出院时使用高流量鼻导管，脉搏血氧饱和度在 95%以上。出院半年后，她发展为闭塞性细支气管炎后遗症。
RSV 可能是 PB 的病因之一，尤其是在免疫功能低下的儿童中。在患有肺部感染的患者中，如果出现低氧血症且对机械通气甚至 ECMO 无反应，应考虑 PB，并尽快进行支气管镜检查以明确诊断并进行治疗。
