International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
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Case Report

Volume 11, Number 1, March 2022, pages 20-26

The Management of Influenza Virus-Induced Plastic Bronchitis in Pediatric Patients: A Case Report and Literature Review


Figure 1.
Figure 1. Chest radiography and computed tomography on admission day. (a) Chest radiography on admission revealed the low permeability in the left lung field. (b, c) Chest computed tomography (axial and coronal) revealed the decreasing permeability in the left lung field.
Figure 2.
Figure 2. Clinical course after admission. This figure showed time course of applied medicine and chest radiography. SBT/AMPC: sulbactam/ampicillin; AMPC/CVA: amoxicillin-clavulanate.
Figure 3.
Figure 3. Chest computed tomography on day 4 following admission (axial and coronal) revealing the total atelectasis in the left lung field and a mucous plug in the left bronchus.
Figure 4.
Figure 4. (a-f) Bronchoscopic visualization of secretions in the bronchus with patent left lobe orifice. The author (presenter, otolaryngologist) performed flexible bronchoscopy, which revealed a whitish rubbery material occluding the left lower lobe bronchus, and plastic casts were removed. The casts fragmented were removed by extraction via suctioning during fiberoptic bronchoscopy.
Figure 5.
Figure 5. Gross findings demonstrate the fragmentation of casts.
Figure 6.
Figure 6. Chest radiography after bronchoscopic suctioning. (a) Finding immediately after bronchoscopic suctioning. After bronchoscopic removal of casts, the atelectasis finding in the left upper lung on chest radiography was improved. (b) Chest radiography revealed a marked improvement in the left lung.
Figure 7.
Figure 7. (a, b) Sputum cytopathology (hematoxylin and eosin stain, × 40). Numerous eosinophils were found; however, an evident malignant finding was not found. Eosinophils were considered the inflammatory cells. Charcot-Leyden crystals were not observed.


Table 1. Laboratory Data on Admission
aThese are results of October 3 (hospital day 3). WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; Ht: hematocrit; Plt: platelet; UN: urea nitrogen; Cr: creatinine; TP: total protein; Alb: albumin; TB: total bilirubin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; Ig: immunoglobulin; CRP: C-reactive protein; RSV: respiratory syncytial virus; Flu: influenza virus; IFN: interferon; MG: microglobulin; NAG: N-acetyl-β-D-glucosaminidase.
WBC8.2 × 103/µL
RBC491 × 104/µL
Hb13.3 g/dL
Plt25.8 × 104/µL
Na139 mmol/L
K4.3 mmol/L
Cl105 mmol/L
UN8.0 mg/dL
Cr0.23 mg/dL
TP7.2 g/dL
Alb4.7 g/dL
TB0.5 mg/dL
IgG985 mg/dL
IgA52 mg/dL
IgM175 mg/dL
CRP0.10 mg/dL
Non-specific IgE209 IU/dL
Ferritin30 ng/dL
Flu (A/B)(-/-)
Blood cultureNegative
Tuberculosis specific IFN-γ(-)
β2-MGa260 µg/L


Table 2. A Total 35 Cases of Pediatric Patients With Influenza Virus-Induced Plastic Bronchitis in Previous English Reports
Influenza type AInfluenza type B
CT: computed tomography.
CaseN = 28N = 7
Sex (boy/girl)25:36:1
Age1 year and 10 months to 11 years5 years to 8 years
  Average age4.4 years6.9 years
  Median age4 years6 years
NationalJapanese: 10Japanese: 4
Korean: 1American: 3
Chinese 17
Underlying disease (allergy)11/283/7
Affected side on chest X-ray or CT
  Antiviral drug21/286/7
  Antibacterial drug8/284/7
  Bronchoscopic removal28/287/7
Mechanical ventilation25/286/7
Outcome26/28 improve including: 2/28 recurrence (the second attack was infected with influenza type B) improve, 2/28 death7/7 improve including: 1/7 recurrence (the second attack was infected with influenza type A) improve