Asthma-Related Plastic Bronchitis: A Challenging Diagnosis

Plastic bronchitis (PB) is a rare but potentially life-threatening condition characterized by the formation of bronchial casts, leading to airway obstruction. It is associated with several underlying conditions, including congenital heart disease, respiratory infections, and asthma. Due to its non-specific symptoms, PB is often misdiagnosed or underdiagnosed. We present a case of a 10-year-old boy with a one-year history of recurrent productive cough, dyspnea, and fever, unresponsive to albuterol treatment. Chest X-rays revealed atelectasis of the left lower lung, which persisted despite airway clearance techniques. High- resolution computed tomography (HRCT) showed collapse consolidation of the left lung. Bronchoscopy revealed bronchial obstruction by a rubbery cast, which was successfully removed. Pathologic analysis of the cast showed eosinophils, neutrophils, and Charcot-Leyden crystals. The patient was treated with inhaled corticosteroids and short-acting beta-agonists, leading to complete resolution of symptoms. Follow-up after six months showed no recurrence of symptoms. This case highlights the importance of considering PB in patients with recurrent respiratory symptoms and atelectasis, particularly when foreign body aspiration or common respiratory diseases have been ruled out. Early diagnosis and management, including cast removal and treatment of underlying conditions, are crucial to preventing complications.