Resolution of lobe collapse in a child with cystic fibrosis with M.
abscessus using serial intrabronchial rhDNase
Abstract
An eight-year-old girl with cystic fibrosis (CF) developed a left upper
lobe collapse failing to resolve with initial conventional antibiotic
treatment, mucolytics and intensified physiotherapy. Mycobacterium
abscessus was isolated from her sputum. Bronchoscopy revealed thick
viscous mucus plugging of the left upper lobe bronchus with complete
obliteration. Three bronchoscopies with saline lavage and Dornase alfa,
a rhDNase, at the end of each procedure resulted in removal of this
mucus plug and the re-inflation of the affected lobe, with clinical and
radiological resolution. The use of flexible bronchoscopy as a
‘secondary’ treatment with 0.9% saline lavage and instillation of
rhDNase is described sparsely in the literature. This is the first
reported successful therapeutic resolution of a lung collapse in a CF
patient with Mycobacterium abscessus, with sequential therapeutic
bronchoscopies with instillation of Dornase alfa. This should be
considered for lobar collapse in CF not responding to the standard
therapeutic regime.