CASE REPORT article
Front. Pediatr.
Sec. Pediatric Pulmonology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1632989
Case report: Aspergillus fumigatus-associated plastic bronchitis in a pediatric patient with cystic fibrosis complicated by allergic bronchopulmonary aspergillosis
Provisionally accepted
- 1Shengjing Hospital of China Medical University, Shenyang, China
- 2The First Hospital of Yulin, Yulin, China
- 3Sheng Jing Hospital Affiliated, China Medical University, Shenyang, China
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While plastic bronchitis (PB) is most commonly associated with viral pathogens and Mycoplasma pneumoniae (MP) infections, fungal etiologies are exceptionally uncommon in children. We described a case of a 10-year-old girl with Aspergillus fumigatus-induced PB. She had a ten-month history of intermittent coughing as the predominant symptom, without acute progressive dyspnea. Her medical history included cystic fibrosis (CF) complicated by allergic bronchopulmonary aspergillosis (ABPA). The bronchoscopy revealed a large amount of thick, gelatinous mucus plugs in the right lower lobe bronchus. After two fiberoptic bronchoscopy procedures, the plugs were removed and turned out to be large gelatinous bronchial casts. Fungal culture of the bronchoalveolar lavage fluid(BALF) was positive for Aspergillus fumigatus, and pathological examination of the bronchial casts revealed Aspergillus hyphae. This case demonstrates a chronic onset process, with significantly delayed cast formation compared to PB cases caused by other pathogens. Notably, Aspergillus fumigatus-associated casts exhibited marked differences in CT imaging characteristics, gross morphological features and histopathological profiles when compared to MP-associated casts. The current case suggests that Aspergillus fumigatus may be an additional cause of PB. Clinicians should include this pathogen in the differential diagnosis of patients presenting with prolonged symptom duration, CT evidence of high-attenuation mucus plugs and casts exhibiting gelatinous texture. distress, and even respiratory failure, which can be life-threatening in severe cases (2,3). Prompt recognition of this disease and the removal of the casts are crucial.
Keywords: Plastic bronchitis, Bronchial casts, Aspergillus fumigatus, Fiberoptic bronchoscopy, Allergic bronchopulmonary aspergillosis, Cystic Fibrosis
Received: 22 May 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Liu, Zhao, Gao, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Han Zhang, Sheng Jing Hospital Affiliated, China Medical University, Shenyang, China
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