A 35-year-old woman with no history of lung disease or occupational exposures and no active or passive cigarette smoking.
She had presented for evaluation of a chronic cough productive of voluminous secretions.
Over the previous 3 months, she had experienced episodic wheezing and dyspnea. During these episodes she often expectorated thick secretions which she described as resembling squid. Admitted to the pulmonary department she had no other respiratory or expiratory symptoms.
In clinical examination, heart rate was 96 bpm and polypnea was at 26 cpm, with condensation syndrome of all the left hemithorax. The chest-X ray showed a large opacity of the entire left hemithorax with attraction of the mediastinum element towards the opacity (Figure 1).
Computerised axial tomography of the chest confirmed a total left lung atelectasis without any pathological mediastinal node, oriented towards an endobronchial obstacle (Figure 2).
The x-pert MTB/RIF detects no DNA sequences specific for mycobacterium tuberculosis in specimen sputum. Flexible bronchoscopy demonstrated tenacious, thick, and sticky whitish secretions blocking the left stem bronchus.
This materiel was extracted, and inspection demonstrated a bronchial cast, whose pathological analysis revealed necrotic epithelial cells, some eosinophils, and Charcot-Leyden crystals (Figures 3(a) and 3(b)). Two days after bronchoscopy, the patient rejected more bronchial casts, and dyspnea improved. Control of chest-x-ray revealed complete left lung aeration (Figure 4).
The diagnosis of idiopathic plastic bronchitis was retained.
Despite several therapies with antimicrobials, glucocorticoids, and inhaled hypertonic saline, the patient continued to have extensive cast production over the next year.
She underwent repeat flexible bronchoscopy and small casts are rejected continually; she is always followed-up in the pulmonary department.