EC Pulmonology and Respiratory Medicine

Background: Cast bronchitis, also known as plastic bronchitis (PB), is an uncommon juvenile pulmonary illness characterized by the formation of branching bronchial casts that partially or completely obstruct the bronchial lumen.

Objective: To present a rare case of recurrent type 1 cast bronchitis in a child with asthma.

Methodology: A retrospective chart review of a patient recurrent type 1 cast bronchitis in a child with Asthma and literature review.

Case Presentation: A 13-year-old boy with persistent respiratory symptoms, including cough, shortness of breath, and exercise intolerance, was frequently hospitalized due to bronchopneumonia. Despite treatment for asthma and cat allergy, his condition showed only partial improvement. At 12 years of age, his symptoms rapidly progressed, prompting hospitalization. Tests revealed elevated eosinophils and a Class 4 RAST result for cat epithelium. Imaging showed obstructive collapse of the right lower lobe. Bronchoscopy identified a cast in the right upper lobe, which was partially extracted. Pathology revealed inflammation, fibrin, and eosinophils. Due to residual casts and inconclusive results, the patient was readmitted a month later, and a second bronchoscopy revealed additional casts, which were again removed. Pathology showed similar findings. After treatment with oral steroids and continued inhalers, the patient improved significantly, although some mucus plugging persisted in the left lung. So, the patient started on benralizumab and showed a good improvement.

Conclusion: Cast bronchitis is a rare, potentially lethal illness in children that requires a high index of suspicion for diagnosis and treatment. While bronchoscopic removal of bronchial casts and medication are primary therapeutic options, patients with recurrent cast formation are at high risk for surgical intervention, such as lobectomy or pneumonectomy.

 Keywords: Type 1 Cast Bronchitis; Child; Asthma; Lobectomy; Pneumonectomy; Plastic Bronchitis (PB)

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