Case Synopsis: Late, Recurrent Pneumonia From Endobronchial Sutures

Endobronchial suture should be considered in patients with recurrent pneumonia that is unresponsive to medical therapy.
Endobronchial suture should be considered in patients with recurrent pneumonia that is unresponsive to medical therapy.

Children with late and recurrent onset of pneumonia should undergo detailed evaluation of bronchoscopy to find underlying causes, according to a case report published in Medicine.

Recurrent pneumonia has predisposing factors that include wheezing, chronic rhinosinusitis with postnasal drip, atopy/allergy, and asthma. Common underlying diseases of childhood recurrent pneumonia include congenital or acquired anatomical abnormalities of the respiratory system, immune disorders, congenital heart diseases, primary ciliary dyskinesia, among others.

Yiheng Zan, MD, from the West China Medical School in Sichuan, China, and colleagues detailed their findings regarding a 12-year-old girl who presented with recurrent pneumonia.

The patient was admitted with complaints of recurrent fever and cough for more than 1 month. The fever was not accompanied by chills or rash. Her cough was dry at first but became more frequent and productive. The patient also had dizziness. She was treated for 7 days with amoxicillin and clavulanate potassium and 2 days with cefoperazone sodium, tazobactam, and penicillin. Her symptoms did not improve.

The girl had been involved in a car crash that led to fracture of her left ribs and mandible and rupture of the trachea 7 years ago. She received an operation to repair the broken trachea and lung. As a result, she had pneumonia almost every year.

Chest computerized tomography revealed stenosis or occlusion in the proximal end of left main bronchus, along with pleural effusion, consolidation, and partial atelectasis in the lower lobe of the left lung. After undergoing bronchoscopy, surgical sutures were found in the left main bronchus. 

The sutures were taken out by forceps. She received piperacillin/tazobactam with much improvement of her symptoms.

Dr Zan's group noted that endobronchial suture should be considered in patients with a history of thoracic surgery and persistent cough that is unresponsive to medical therapy and that repeated bronchoscopy is necessary to document resolution of granulation tissue and to assure that no underlying pathology is obscured by the inflammatory response.

“Children with recurrent pneumonia should be evaluated by bronchoscopy as early as possible to find out underlying causes, which can reduce misdiagnosis and recurrence,” the study authors concluded.

Reference

  1. Zan Y, Liu H, Zhong L, et al. Childhood recurrent pneumonia caused by endobronchial sutures: A case report [published online January 5, 2017] Medicine (Baltimore).  doi: 10.1097/MD.0000000000005992
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