A rare case of type II negative pressure pulmonary edema following extraction of inhaled peanuts in a 21-month-old boy

To date, only one case of pediatric type II negative pressure pulmonary edema (NPPE) caused by removal of an endobronchial foreign body has been documented. We report another case of type II NPPE that developed after extraction of inhaled peanuts. A 21-month-old boy who presented with wheezing and intermittent cough for 1 month after eating peanuts was admitted to our department. A chest computed tomographic scan showed foreign bodies lodged in the right main bronchus. Fiberoptic bronchoscopy was performed, and three pieces of peanuts were removed. Fifteen minutes after this procedure, the child grew restless and started coughing with frothy pink sputum. Tachypnea and rales were observed. A chest radiograph showed patchy opacification in both lungs, especially in the right lower zone, leading to the diagnosis of type II NPPE. Intravenous furosemide and dexamethasone were immediately administered, followed by non-invasive continuous positive airway pressure ventilation. Twelve hours later, the patient recovered uneventfully and was discharged home the following day. In conclusion, pediatric type II NPPE rapidly occurs following the relief of upper airway obstruction. Clinicians need to be aware of the acuteness and manifestations of type II NPPE to make an early diagnosis and initiate prompt treatment.