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Laryngeal Manifestations of Crohn's Disease in a Toddler with Very Early Onset-IBD
Ian A Schonman1, Sona Sehgal1,2, Luv R Javia3
1George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Insights
Laryngeal Crohn's disease is rare, especially in children. This case highlights a toddler requiring a tracheotomy for severe airway obstruction due to Crohn's disease, emphasizing the need for vigilant diagnosis and management.
Area of Science:
- Gastroenterology
- Otolaryngology
- Pediatric Inflammatory Bowel Disease
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Extra-intestinal manifestations (EIMs) of CD can affect various organs, including the larynx.
- Laryngeal involvement in CD is infrequent, particularly in pediatric populations.
Observation:
- A toddler with very early-onset inflammatory bowel disease (VEO-IBD) presented with severe, recalcitrant airway obstruction.
- The obstruction was attributed to laryngeal manifestations of Crohn's disease, specifically supraglottic inflammation.
- Maximal medical therapy, including steroids and biologics, failed to alleviate the airway compromise, necessitating tracheotomy placement at 27 months of age.
Findings:
- This case represents the youngest patient reported with laryngeal Crohn's disease requiring tracheotomy.
- Laryngeal involvement in CD is rare, with only 14 prior cases documented in the literature, predominantly in adults.
- Despite ongoing systemic Crohn's disease, the laryngeal manifestations improved, allowing for decannulation within a year.
Implications:
- Laryngeal manifestations of Crohn's disease, though rare, can lead to severe airway obstruction requiring intervention.
- While medical management is standard, tracheotomy or surgical intervention may be necessary for temporary airway relief in refractory cases.
- This case underscores the importance of considering laryngeal involvement in VEO-IBD patients with respiratory symptoms.
Objectives:
We report obstructing laryngeal manifestations of Crohn's disease in a toddler with very early onset-IBD (VEO-IBD) who required tracheotomy tube placement at 27 months of age for relief of recalcitrant airway obstruction unresponsive to maximal medical therapy. We review the literature for the frequency of extra-intestinal laryngeal manifestations of Crohn's disease in adults and children.
Methods:
Case report and literature review of laryngeal manifestations of Crohn's disease.
Results:
Laryngeal involvement of Crohn's disease is very rare with only 14 other cases reported. Most cases appear in adults, with the supraglottis most commonly affected. This case marks the youngest report and only the second report of a patient requiring a tracheotomy for supraglottic obstruction when intensive medical management, including use of steroids and biologics, failed to relieve obstructing laryngeal inflammation. Despite ongoing Crohn's disease, laryngeal manifestations improved permitting decannulation the following year.
Conclusions:
Laryngeal manifestations of Crohn's disease are rare and usually affect adults. Most cases are managed with medical therapy, however surgical excision of obstructing lesions or tracheotomy placement is sometimes required for temporary relief of airway obstruction.
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