Food for Thought: Dietary Intervention in a Rare Cause of Se
Plastic bronchitis is an uncommon condition characterised by endobronchial cast formation. Alternative descriptors include cast bronchitis, Hoffman’s bronchitis, fibrinous bronchitis and pseudomembranous bronchitis. It was first described by Galen in the second century AD as ‘venae arteriosae expectorantii’, translated as ‘expectorated arteries and veins’. Proposed mechanisms include the inflammatory response in asthma, raised pulmonary venous pressures after the Fontan procedure, and lymphatic abnormality leading to chyle leakage.

This report is the case of a 53-year-old women who deteriorated following an elective bronchoscopy procedure. She developed refractory ventilatory failure and required repeated bronchoscopy, which identified thick tenacious casts as the cause of her airway compromise. She did not respond to conventional therapies including endoscopic clearance, mucolytic therapy and nebulised tissue plasminogen activator (TPA). Total parenteral nutrition and a fat-free enteral diet were instituted while the patient was on extracorporeal membrane oxygenation (ECMO), which led to substantial improvement in her condition and demonstrated the importance of dietary strategies in this case.