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Granulomatous Inflammation Causing Severe Supraglottic Edema and Airway Obstruction in a Pediatric Patient

Sophia M Colevas1, Bradley T Gietman1, Shelly M Cook2

  • 1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 5232University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Ear, Nose, & Throat Journal
|November 25, 2020
PubMed

Insights

A pediatric patient with sleep-disordered breathing had chronic granulomatous swelling of the supraglottic larynx. Management included airway support and laryngeal procedures, leading to decannulation.

Area of Science:

  • Otolaryngology
  • Pediatric Gastroenterology
  • Pulmonology

Background:

  • Inflammatory bowel disease (IBD), particularly Crohn disease (CD), can manifest in the upper airway.
  • Laryngeal involvement in pediatric CD is rare, with limited case reports available.
  • Granulomatous inflammation of the supraglottic larynx presents diagnostic and management challenges.

Observation:

  • A 12-year-old male with a family history of IBD presented with sleep-disordered breathing.
  • Examination revealed chronic, granulomatous supraglottic laryngeal swelling.
  • The patient underwent tracheostomy, laryngeal steroid injections, supraglottoplasty, and CO2 laser resurfacing.

Findings:

  • The patient was successfully decannulated after multidisciplinary airway management.
  • Differential diagnoses included Crohn disease and laryngeal sarcoidosis due to non-necrotic granulomatous inflammation.
  • This case highlights the rarity of laryngeal CD in pediatric patients (2 of 13 reported cases).

Implications:

  • This case adds to the limited literature on pediatric laryngeal manifestations of Crohn disease.
  • Effective management strategies for supraglottic edema with unclear etiology are discussed.
  • Early recognition and intervention are crucial for managing airway compromise in pediatric IBD.

Keywords:
Crohn diseasesleep-disordered breathingsupraglottitistracheostomy

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