Abstract
We describe a 7-year-old girl with recurrent prolonged periods of coughing since 2 weeks of age. First seen at the University of Iowa Pediatric Pulmonary Clinic at 5 months of age, a flexible bronchoscopy and bronchoalveolar lavage found tracheomalacia (TM) and protracted bacterial bronchitis (PBB). A repeat bronchoscopy at 4 years of age performed because of continued recurrences of chronic cough showed TM essentially the same as seen at 5 months with the neutrophilia and bacteriology typical for PBB. Computerized tomography (CT) at age 7 performed because of continued recurrences of prolonged coughing responsive to amoxicillin–clavulanate demonstrated a narrowed anterior mediastinum causing vascular compression of the trachea by the great vessels. The decrease in the anterior mediastinal space was caused by the absence of the normal dorsal curvature of the upper spine. This abnormality is known as the straight back syndrome (SBS). While previous reports of the SBS focused on the potential for cardiac anomalies, this patient manifested recurrent PBB as a result of this anomaly. The observations in this patient are consistent with other data that support intrathoracic airway malacia as being an important contributing factor for PBB.
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