Plastic Bronchitis: A Manifestation of Dander Hypersensitivity
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e familial inheritance with a report of six cases in a family. Respiration. 2001;68:204-9. 5. Huqun, Izumi S, Miyazawa H, Ishii K, Uchiyama B, Ishida, et al. Mutations in the SLC34A2 gene are associated with pulmonary alveolar microlithiasis. Am J Respir Crit Care Med. 2007;175:263-8. 6. Shah M, Joshi JM. Bone scintigraphy in pulmonary alveolar microlithiasis. Indian J Chest Dis Allied Sci. 2011; 53:221-3.
Plastic Bronchitis: A Manifestation of Dander Hypersensitivity
bronchus which could not be aspirated by multiple lavage attempts. A tree shaped, branching bronchial cast was removed from the left main bronchus via rigid bronchoscopy (Fig. 1a). Baby was weaned off from ventilator over next 24 hours. Nebulized 3% saline was used along with chest physiotherapy for pulmonary toileting. Charcot-Leyden crystals with eosinophils and polymorphs were demonstrated on cytopathological examination of broncho-alveolar lavage (BAL) (Fig. 1b). Cast histopathology showed eosinophils with necrotic background (type1 variety). Total immunoglobulin E (IgE) level was raised (276 IU/ml) with positive skin prick test (SPT) for buffalo dander. SPT for milk, egg, house dust, house dust mite, cow dander and wheat grass were negative. SPT was done with commercially available allergen extracts (Alcure Pharma) for local flora and fauna with valid positive and negative controls. Sweat chloride test and echocardiography was normal. The eczematous lesions over his back responded well to topical therapy. With a suggestive history of atopy, skin and respiratory manifestations, presence of Charcot Leyden crystals with eosinophils in cast and positive SPT for buffalo dander, an IgE-mediated allergic phenomenon was the most appropriate possibility. He was discharged on inhaled corticosteroids and oral montelukast with instructions to avoid buffalo dander, by shifting to maternal grandparents’ home, and an emergency action-plan. Inhaled steroids were tapered over next 9 months. The child remained asymptomatic at 1-year in follow-up on montelukast alone and allergen avoidance measures.
Plastic bronchitis, an entity with grave prognosis, is characterized by formation of large, branching bronchial casts obstructing the tracheobronchial tree. It has been previously reported in children with cyanotic congenital heart disease (CHD), asthma, allergic broncho-pulmonary aspergillosis (ABPA) and cystic fibrosis. A 9-month old boy presented with severe respiratory distress which required invasive ventilation for type-2 respiratory failure. He had received inhaled bronchodilators twice for recurrent cough in last 3 months. His grandfather had asthma and required inhaled medications. The child had exposure to animal dander (buffalo and cow) and wheat dust from nearby farm since birth. At admission, child had end-expiratory wheeze in left axillary area. High requirement of lung inflation pressures and loss of alpha-angle on end-tidal carbon dioxide graphic suggested obstructive airway. Salbutamol and ipratropium bromide nebulization along with systemic glucocorti
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