Extensive plastic bronchitis: etiology of a rare condition

We present the case of a 55-year-old man who developed extensive occlusive bronchial casts after trachea-esophageal (TE) fistula repair. The bronchial casts were treated by bronchoscopic extraction, high dose steroids, antibiotics, and antifungals. Despite this multi-modality treatment, the rapid formation of these occlusive bronchial casts was very aggressive and could not be controlled even with a series of five rigid bronchoscopic extractions within a 48-hour period. The patient quickly deteriorated and succumbed to the inflammatory state. The multiple factors that might have led to the patient’s bronchial cast formation are discussed.