Abstract Introduction Plastic bronchitis (PB) and obliterative bronchiolitis (OB) are rare, severe pulmonary disorders in children, typically arising from distinct underlying etiologies. To date, there are no previous reports describing the coexistence of Hodgkin’s lymphoma with PB and OB prior to hematopoietic stem cell transplantation (HSCT). Case Presentation A 12-year-old girl presented with a 3-day history of fever, productive cough, and dyspnea. Her past medical history included classic Hodgkin’s lymphoma, nodular sclerosis subtype, stage IV, and was during OEPA-COPDAC chemotherapy (third cycle completed 20-days earlier). On admission, she was tachycardic, tachypneic, and hypoxic, with diminished breath sounds, bilateral wheezing, and forced expiration. Laboratory studies showed elevated inflammatory markers; blood and respiratory cultures, and FilmArray were negative. Chest X-ray revealed diffuse interstitial opacities. She received empirical broad-spectrum antibiotics for presumed pneumonia in an immunocompromised host, with partial improvement. Nine days later, fever recurred and respiratory symptoms persisted. HRCT demonstrated diffuse ground-glass opacities, some areas with a nodular appearance. Bronchoscopy and bronchoalveolar lavage were negative for infection, but tenacious, rubbery mucus casts were retrieved. Histology revealed mucoid material with sparse inflammatory cells, confirming plastic bronchitis. The patient’s mother later reported similar mucus expectoration 4-months before the oncologic diagnosis. Echocardiography showed mild pulmonary hypertension, and lymphangiography was unavailable. Cast expulsion ceased with treatment, and oxygen was successfully weaned. Subsequently, disease progression was confirmed, and salvage chemotherapy was initiated. The patient developed worsening cough and dyspnea with radiologic evidence of upper-lobe–predominant parenchymal progression. Lung biopsy revealed lymphohistiocytic inflammatory infiltrate with frequent polymorphonuclear neutrophils and fibroblastic plugs (organizing pneumonia). Pulmonary function tests showed decreased diffusing capacity (DLCO), increased lung volumes due to an increase in residual volume, and a normal flow-volume curve without significant response to the bronchodilator. OB was diagnosed, and therapy was optimized with inhaled dornase alfa, heparin, budesonide/formoterol, tiotropium, and azathioprine. Multidisciplinary consensus led to autologous HSCT. At day +383 post-transplant, she remained asymptomatic, without recurrence of bronchial casts, and with stable pulmonary function. Conclusion In children, PB is most commonly associated with Fontan physiology or infection, while OB typically follows infection, HSCT or lung transplantation. Only one pediatric case has linked PB to Hodgkin’s lymphoma as a paraneoplastic manifestation, possibly due to lymphatic obstruction from mediastinal disease. OB has also been described as a paraneoplastic or chemotherapy-related complication in adults. Given the rarity of these entities and limited therapeutic evidence, this case highlights the importance of multidisciplinary management and long-term follow-up. This abstract is funded by: None
Parra et al. (Fri,) studied this question.