Pulmonary outcomes of pediatric patients with postinfectious bronchiolitis obliterans treated with pulse methylprednisolone and intravenous immunoglobulin: a single-center cohort study.

Postinfectious bronchiolitis obliterans (PIBO) is a severe chronic pulmonary disorder in children, characterized by irreversible airway obstruction following acute lower respiratory tract infections. Currently, there is no consensus on the treatment protocol for PIBO. This study aimed to evaluate the safety and effectiveness of combining intravenous pulse methylprednisolone (IVPM) with intravenous immunoglobulin (IVIG) in pediatric patients with PIBO. We conducted a retrospective single-center cohort study that included 18 children diagnosed with PIBO at a tertiary pediatric pulmonology center. Patients received monthly cycles of IVPM (10 mg/kg/day for 3 days) and IVIG (1 g/kg for 2 days) over a six-month period. After the first three cycles, the IVPM/IVIG therapy was evaluated for side effects and clinical improvement. Treatment continued for all patients since no complications were observed. Clinical, radiological, and laboratory parameters were compared before and after treatment. Following therapy, 83.3% of patients experienced symptomatic and clinical improvement. Annual wheezing episodes (3.12 ± 0.83 vs. 1.25 ± 0.70; p = 0.014) and hospitalization rates (2.12 ± 0.64 vs. 0.50 ± 0.75; p < 0.001) decreased significantly compared to baseline. Oxygen therapy was discontinued for all patients. The median weight and height z-scores at sixth month of therapy showed improvement, although no significant difference was noted. No serious adverse events were reported; transient hyperglycemia and mild rash were the only side effects observed. Conclusion: This is the first study to evaluate the combination of IVPM/IVIG therapy in pediatric PIBO patients. Our findings suggest that early initiation of this regimen may provide a safe alternative for these patients, with no serious side effects observed. What is Known: • There is no standardized treatment protocol for postinfectious bronchiolitis obliterans (PIBO), and current therapies depend on expert opinion and small case series What is New: • This study evaluates the safety and efficacy of combining intravenous pulse methylprednisolone (IVPM) with intravenous immunoglobulin (IVIG) in pediatric PIBO patients • The study demonstrates that IVPM/IVIG therapy initiated at a younger age and in earlier stages of the disease may improve clinical outcomes while decreasing hospitalization and episodes of wheezing.