Plastic bronchitis in beta thalassemia minor
A 33-year-old woman with beta thalassemia minor was hospitalized with productive cough, dyspnoea with wheezing, and chest pain predominantly in interscapular area, ongoing since six months. There were no symptoms of asthma since childhood, or atopy in self or family. The patient was treated with empirical anti-tuberculous treatment without any relief, and then was referred to our side. The patient was previously diagnosed case of beta thalassemia minor as a part of workup done for her daughter who has Thalassemia major. General examination was normal. Respiratory system examination showed movements reduced on left with signs of volume loss, dull note on percussion, and reduced intensity of breath sounds over left hemi thorax. Blood hemogram was within normal limit. Sputum for acid fast bacilli smear and culture was negative. Chest radiograph [] showed left lung collapse which was confirmed on computed tomography []. Bronchoscopy showed stenosed left mainstem bronchus just distal to carina with viscid secretions. The secretions were successfully aspirated. Her bronchial washings and post-bronchoscopy sputum for cytology were negative for malignant cells. Histopathology of the biopsied stenosed site was suggestive of respiratory epithelium with mucous. The patient was treated with oral corticosteroids, bronchodilators, N-acetyl cysteine nebulization, and vigorous chest physiotherapy for 3 months. In the mean time the patient continued to expectorate bronchial casts []. Post-treatment there was evidence of response noted clinically by improvement in intensity of breath sounds, radiologically by re-expansion of base of left lung confirmed on computed tomography [] which showed aeration of upper and lower lobe with persistent post-obstructive collapse of the lingula.