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Expectoration of bronchial casts in association with Ramipril treatment

  • Kim Sarah Plümacher (a1), Thomas Paul (a1) and Matthias Sigler (a1)


We report of a 26-year-old female patient who was referred to our centre with congestive heart failure (CHF). Acute myocarditis with a high Parvovirus B19 virus load was diagnosed by myocardial biopsy. CHF improved after start of ramipril 5 mg/d, metoprolol, diuretics, immunoglobins, and a 24-hour infusion of levosimendan. Soon after initiation of medical therapy, the patient started to expectorate bronchial casts with varying frequencies (three times per week to five times daily). Thorough pneumological workup, including histology of the casts, microbiology, and a CT scan of the lungs, did not reveal any cause for bronchial cast formation. Inhalative corticoids were started without any benefit. Two years later, cardiac catheterisation demonstrated normalised left ventricular function. LV end-diastolic pressure, however, was still elevated at 14 mmHg. Endomyocardial biopsies at this time were negative for virus genome. Finally, we changed afterload reduction therapy from ramipril to candesartan. Within 24 hours, expectoration of bronchial casts terminated. Four weeks later, re-exposition to ramipril prompted immediate re-appearance of cast formation, which again stopped with switching back to candesartan. Finally, we were to prove that treatment with ramipril resulted in bronchial cast formation in this patient.


Corresponding author

Author for correspondence: K. S. Plümacher, MD, Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Medical Center, Robert-Koch-Str. 40, D-37075 Göttingen, Germany. Phone : + 49-551-39-66203; Fax: + 49-551-39-22561; E-mail:


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1. Schumacher, KR, Singh, TP, Kuebler, J, Aprile, K, O’Brien, M, Blume, ED. Risk factors and outcome of Fontan-associated plastic bronchitis: a case-control study. J Am Heart Assoc 2014; 3: 16.
2. Kunder, R, Kunder, C, Sun, HY. Pediatric plastic bronchitis: case report and retrospective comparative analysis of epidemiology and pathology. Case Rep Pulmonol 2013; 2013: 649365. doi: 10.1155/2013/649365
3. Avitabile, CM, Goldberg, DJ, Dodds, K, Dori, Y, Ravishankar, C, Rychik, J. A multifaceted approach to the management of plastic bronchitis after cavopulmonary palliation. Ann Thorac Surg 2014; 98: 634640.
4. Schmitz, J, Schatz, J, Kirsten, D. Plastic bronchitits. Pneumologie 2004; 58: 443448.
5. Brooks, K, Caruthers, RL, Schumacher, KR, Stringer, KA. Pharmacotherapy challenges of fontan-associated plastic bronchitis: a rare paediatric desease. Pharmacotherapy 2013; 33: 922934.
6. Singhi, AK, Vinoth, B, Kuruvilla, S, Sivakumar, K. Plastic bronchitis. Ann Pediatr Cardiol 2015; 8: 246248.
7. Barnes, PJ, Chung, FK, Page, CP. Inflammatory mediatores of asthma: an update. Pharmacol Rev 50: 515596.
8. Abraham, WM, Scuri, M, Farmer, SG, Peptide and non-peptide bradykinin receptor antagonsits: role in allergic airway disease. Eur J Pharmacol 2006; 533: 215221.


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Expectoration of bronchial casts in association with Ramipril treatment

  • Kim Sarah Plümacher (a1), Thomas Paul (a1) and Matthias Sigler (a1)


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