[Assessment of airway lesions using "virtual bronchoscopy" in a patient with relapsing polychondritis]

A 44-year-old woman was referred to our department complaining of a persistent cough and dyspnea which were resistant to inhaled corticosteroids or a bronchodilator. In addition, she suffered tenderness on the sternum, costicartilage, and bilateral fingers of both hands as well as sensorineural deafness. Virtual bronchoscopy images, re-constituted from three dimensional computed tomography, revealed the thickness of the pan-tracheal wall ranging from the vocal cord towards the bilateral bronchi. These lesions showed an increased uptake in gallium-67 scintigraphy. Enhanced levels of an anti-type II collagen antibody were detected. These findings and symptoms satisfied Damiani's criteria of diagnosis and thus relapsing polychondritis was diagnosed. Treatment with oral prednisolone (40 mg/day) was started. Her cough improved immediately, and two months later virtual bronchoscopy showed improvement in the tracheal wall thickness. The level of the anti-type II collagen antibody was also attenuated, along with a decreased uptake of gallium-67 scintigraphy. However, the virtual bronchoscopy demonstrated that the cartilage ring surrounding the trachea and bronchi remained absent, suggesting the cartilage was already destroyed. Our case demonstrated that virtual bronchoscopy plays a key role in the assessment of airway lesions in relapsing polychondritis.