Relapsing Polychondritis: A Case of Marked Improvement After Steroid Administration for Airway Obstruction

Relapsing polychondritis is a rare disease that causes progressive and recurrent destruction of cartilage in the auricles, eyes, nose, and airways. A 90-year-old man was brought to the emergency department with fever, low SpO₂, and effortful breathing. Arterial blood gas analysis showed that PaCO₂ levels had accumulated to 120 mmHg. Although CT showed marked thickening of the bronchial wall from the central to the peripheral region, the cause was unknown. At the family's request, the patient was not placed on a ventilator, and treatment was started with steroids alone. After admission, the patient's condition improved with only intravenous steroids, and he was discharged to the facility with continued oral steroid medication. After a short treatment period, the possibility of relapsing polychondritis was considered and confirmed. The patient met Levine's diagnostic criteria, with findings of destruction of the bilateral auricular cartilage and the airway and a response to steroid administration. Although it is very difficult to diagnose relapsing polychondritis at the initial emergency department visit, early administration of steroids is worth trying in patients with asphyxia with extensive thickening of the airway on CT findings, as relapsing polychondritis may be considered, and early steroid administration may improve patient symptoms.