Bronchial casts associated with Mycoplasma pneumoniae pneumonia in children

OBJECTIVE: This study was performed to analyze 22 cases of Mycoplasma pneumoniae pneumonia (MPP) associated with bronchial casts (BCs) in children. METHODS: We retrospectively reviewed all cases of MPP in children treated at our institution from November 2015 to December 2016. Demographic information, laboratory parameters, radiologic and fiberoptic bronchoscopy findings, treatment outcomes, and follow-up results were analyzed. RESULTS: Among 161 patients with MPP, 22 had BCs and 139 had no BCs. All BCs occurred in a segmental or subsegmental bronchus and were removed by fiberoptic bronchoscopy. Patients with BCs had a longer duration of fever after admission and higher incidence of refractory MPP. Substantially more children with than without BCs had a high M. pneumoniae load in the bronchoalveolar lavage fluid. All patients with BCs but only 55.4% without BCs were given methylprednisolone in addition to the standard antibiotic treatment. A significantly higher proportion of children with than without BCs received oxygen therapy. After discharge, complete radiological resolution took significantly longer in children with than without BCs. CONCLUSIONS: In children with MPP, prompt removal of BCs may be necessary to prevent BC propagation. MPP with BCs is more severe than that without BCs, and treatment and recovery are more difficult.