Rare presentation of atypical pathogens pneumonia as fibrinous inflammation in 8 children in Anhui province, China from 2012 to 2019

Background: M. pneumoniae and adenovirus are generally recognized as a self-limiting illness, but sometimes they will develop into macrolide-resistant M . pneumoniae or refractory adenovirus pneumonia associated with prolonged disease course with increased clinical severity, longer hospital stay and treatment failure. Methods Children with a final diagnosis of atypical pathogens pneumonia presenting as mucus plugs to the Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University were prospectively enrolled between June 2012 and June 2019 . 7 patients were identified as mycoplasma pneumoniae positive IgM and 1 patient was diagnosed as adenovirus infection by enzyme-linked immunosorbent assay . Results All the 8 cases reported in this study were diagnosed as lung infection, while 6 patients had pulmonary consolidation . Histological examination of mucus plugs in patient 3 and 8 revealed a fibrinous exudation. The average duration of m acrolide a ntibiotics treatment was ( 12.86 ± 3.49) days, and the total course of treatment ranged from 7 to 17 days. Patient 5 with adenovirus infection was given ganciclovir for 10 days without using of a ntibiotics. Bronchoalveolar lavage, pulse methylprednisolone, atomization inhalation of salbutamol and budesonide suspension , and intravenous immunoglobulins were performed in these patients. Conclusion We highly suspected that these mucus plugs might be the early presentation of plastic bronchitis. Use of anti-infection treatment ( macrolide a ntibiotics) , corticosteroid, gamma globulin , and other conventional treatments, lung lavage bronchofibroscope have good efficacy and can improve clinical outcomes.