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[A woman with wheezing].

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Summary

A young adult with exercise-induced breathing difficulties was diagnosed with idiopathic subglottic stenosis after asthma treatments failed. This condition involves airway narrowing below the vocal cords, confirmed by imaging and bronchoscopy.

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Area of Science:

  • Pulmonology
  • Otolaryngology

Background:

  • Investigating the differential diagnosis of exercise-induced dyspnea and wheezing.
  • Evaluating treatment-resistant respiratory symptoms in young adults.

Observation:

  • A 26-year-old patient presented with dyspnea and wheezing during exercise, unresponsive to salbutamol.
  • Spirometry demonstrated abnormal inspiratory and expiratory flow-volume loops.
  • Imaging and bronchoscopy revealed circumferential subglottic stenosis.

Findings:

  • Idiopathic subglottic stenosis was diagnosed based on clinical presentation, spirometry, and bronchoscopic findings.
  • Negative ANA/ANCA tests and biopsy showing scar tissue ruled out inflammatory or autoimmune causes.
  • The stenosis was located circumferentially in the subglottic region.

Implications:

  • Highlights the importance of considering subglottic stenosis in patients with unexplained exercise-induced respiratory symptoms.
  • Demonstrates the diagnostic utility of flexible bronchoscopy and CT imaging for subglottic airway evaluation.
  • Emphasizes the need for specialized interventions for idiopathic subglottic stenosis when medical management fails.