s eport Plastic Bronchitis: An Old Disease Revisited JAMES R. JETT, M.D., Division of Thoracic Diseases and Internal Medicine; HENRY D. TAZELAAR, M.D., Division of Pathology; LON W. KEIM, M.D., Division of Pulmonary Medicine, Bishop Clarkson Memorial Hospital, Omaha, Nebraska; THEODORE S. INGRASSIA III, M.D., Division of Thoracic Diseases and Internal Medicine Expectoration of bronchial casts (plastic bronchitis) is an uncommon but ancient problem. Herein we describe a 40-year-old man, with no prior lung disease, who had dyspnea, cough, and expectoration of long branching bronchial casts. No specific cause was delineated, although special stains for eosinophilic granule major basic protein demonstrated occasional foci of eosinophils and small amounts of extracellu- lar major basic protein in the bronchial casts. Various diseases, such as allergic bronchopulmonary aspergillosis, bronchiectasis, and cystic fibrosis, have been asso- ciated with the formation of bronchial casts and should be considered in the differen- tial diagnosis. Although most previously reported cases have been associated with some type of pulmonary disease, our patient had. no evidence of an underlying pulmonary disorder. Plastic bronchitis, also known as fibrinous bron- chitis or pseudomembranous bronchitis, is an uncommon entity that reportedly occurs in chil- dren and adults.l'" It is characterized by the presence of large inspissated bronchial casts that are expectorated, discovered at the time of bronchoscopy, or occasionally identified in lung specimens obtained at operation or autopsy.v" Typically, the initial manifestations are dys- pnea with or without wheezing, cough, fever, and, occasionally, hemoptysis. Most patients have underlying pulmonarydisease.t? The chest roentgenogram reveals a segmental or lobar infiltrate or occasionally whole-lung atelectasis. In children, the differential diagnosis includes pneumonia or aspiration of a foreign object, whereas in adults it is most commonly confused Address reprint requests to Dr. J. R. Jett, Division of Thoracic Diseases, Mayo Clinic, Rochester, MN 55905. with an endobronchial lesion such as broncho- genic carcinoma. Herein we report a case of a middle-aged man, with no priorhistoryof asthma or lung disease, who had plastic bronchitis. REPORT OF CASE A 40-year-old man was referred to the Mayo Clinic for evaluation of right lower lobe pneumo- nitis and cough productive of large bronchial casts. The patient's health had been normal until 2 months earlier, when a cough productive ofthick white sputum had developed. Fever (to 38°C), night sweats, and progressive dyspnea subsequently developed, and expectoration of large bronchial casts prompted admission to his local hospital 6 weeks before the current refer- raL A chest roentgenogram disclosed a right lowerlobe infiltrate. A skin test for tuberculosis was negative. The absolute blood eosinophil count was 560 cells/ram". A differential count of the cellular elements in the sputum revealed 5% Mayo Clin Proc 66:305-311, 1991 305
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
