Plastic bronchitis or cast bronchitis is a rare disease of unclear etiology characterized by formation of airway casts that can lead to life-threatening airway obstruction. There is currently limited data regarding optimal treatment of plastic bronchitis. Several therapies have been suggested, but recurrences are common and mortality remains high. We report the case of a 6-year-old boy with refractory eosinophilic bronchial casts, unresponsive to low-dose systemic corticosteroids, inhaled corticosteroids, azithromycin, and dornase alfa, who was treated successfully and safely with direct instillation of tissue-type plasminogen activator (tPA) to the obstructing casts during flexible bronchoscopy and inhaled tPA. Our case illustrates that the current therapy for plastic bronchitis remains inadequate. To our knowledge, this case is the first to show that direct instillation of tPA can be used safely for treatment of this disease. The use of tPA via direct administration into the airways during bronchoscopy and via a nebulizer appeared to be a safe and effective therapy for plastic bronchitis and should be considered early in the course of the disease to prevent complications of severe airway obstruction.
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August 2012
Case Report|
August 01 2012
Management of Plastic Bronchitis With Topical Tissue-type Plasminogen Activator
Elizabeth Gibb, MD;
aDivision of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, and
Address correspondence to Elizabeth Gibb, MD, Department of Pediatric Pulmonary, University of California, San Francisco, 521 Parnassus Ave, C344, San Francisco, CA 94143. E-mail: gibbe@peds.ucsf.edu
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Robert Blount, MD;
Robert Blount, MD
aDivision of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, and
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Nancy Lewis, MD;
Nancy Lewis, MD
aDivision of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, and
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Dennis Nielson, MD;
Dennis Nielson, MD
aDivision of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, and
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Gwynne Church, MD;
Gwynne Church, MD
aDivision of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, and
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Kirk Jones, MD;
Kirk Jones, MD
bDepartment of Pathology, University of California San Francisco, San Francisco, California
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Ngoc Ly, MD
Ngoc Ly, MD
aDivision of Pulmonary Medicine, Department of Pediatrics, Benioff Children’s Hospital, and
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Address correspondence to Elizabeth Gibb, MD, Department of Pediatric Pulmonary, University of California, San Francisco, 521 Parnassus Ave, C344, San Francisco, CA 94143. E-mail: gibbe@peds.ucsf.edu
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2012) 130 (2): e446–e450.
Article history
Accepted:
February 29 2012
Citation
Elizabeth Gibb, Robert Blount, Nancy Lewis, Dennis Nielson, Gwynne Church, Kirk Jones, Ngoc Ly; Management of Plastic Bronchitis With Topical Tissue-type Plasminogen Activator. Pediatrics August 2012; 130 (2): e446–e450. 10.1542/peds.2011-2883
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