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DOI: 10.1055/s-2005-836608
© Georg Thieme Verlag Stuttgart · New York
Easy Removal of a Large Mucus Plug With a Flexible Paediatric Bronchoscope After Administration of rhDNase (Pulmozyme®)
Problemlose Entfernung eines organisierten Schleimpfropfes nach Vorbehandlung mit rhDNase (Pulmozyme®) mittels eines flexiblen pädiatrischen BronchoskopesPublication History
Publication Date:
24 August 2005 (online)
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Abstract
Mucoid impaction and plastic bronchitis are relatively rare disorders affecting patients of any age. Here we report the case of mucoid impaction developing in a four-year-old child as a complication of pneumonic infection treated four weeks prior. p.a. chest X-ray and fiberoptic bronchoscopy showed atelectasis and the location of a mucus cast in the left upper lobe. After extraction of the cast via the suction channel of the bronchoscope had failed, we administered 2.5 mg of undiluted recombinant human desoxyribonuclease (rhDNase) instilled directly over the affected area of occlusion for 15 minutes. This mucolytic agent mobilized the cast by reducing viscoelasticity and adherence of mucus. Subsequent extraction of the mucus cast was easy, resulting in immediate reduction of atelectasis and discharge of the child the following day. Treatment of severe mucus plugging by direct installition of rhDNase has been a safe and efficacious procedure for mobilising adherent mucus plugs and for facilitating bronchoscopic extraction.
Zusammenfassung
Schleimpfropfbildung und Bronchitis plastica sind relativ seltene Krankheiten, die in jedem Alter auftreten können. Wir berichten über einen vierjährigen Jungen, der vier Wochen nach erfolgreicher Behandlung wegen dystelektatischer Mykoplasmenpneumonie erneut hospitalisiert wurde, diesmal aufgrund einer Schleimpfropfbildung im linken Oberlappen der Lunge, was als Spätfolge der Mykoplasmeninfektion eingestuft wurde. Das Röntgenbild der Lunge wies die typischen Zeichen einer Atelektase im linken Oberlappen auf und mit Hilfe der Bronchoskopie ließ sich der Schleimpfropf ebendort lokalisieren. Nach dem zunächst erfolglosen Versuch, den Pfropf bronchoskopisch zu entfernen, applizierten wir rekombinierte menschliche Desoxyribonuklease (rhDNase; 2,5 ml unverdünnt) für 15 Minuten direkt oberhalb der betroffenen Region. Dieses mukolytische Agens verringerte die Viskoelastizität und Klebkraft des Schleims, so dass wir den Pfropf anschließend leicht mit dem Bronchoskop absaugen konnten; unmittelbar danach verschwand die Atelektase. Der Junge konnte am folgenden Tag entlassen werden und erholte sich ohne weitere Komplikationen. Damit hat sich bei diesem Patienten die direkte Applikation von rhDNase am Ort der Plugbildung als sichere und effektive adjuvante Therapiemaßnahme erwiesen.
Key words
atelectasis - rhDNase-therapy - mucus plug
Schlüsselwörter
Atelektase - rhDNase-Therapie - Schleimpfropf
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Dr. Wolfgang Kamin
Kinderklinik und Kinderpoliklinik der Johannes Gutenberg-Universität Mainz
Langenbeckstr. 1
55101 Mainz
Phone: 0 61 31/17 26 02
Email: kamin@kinder.klinik.uni-mainz.de