A complicated case of relapsing polychondritis: Case report

Area of Science:

• Pulmonology
• Rheumatology
• Critical Care Medicine

Background:

• Relapsing polychondritis (RP) is a rare inflammatory condition.
• RP can cause severe dyspnea and respiratory distress, mimicking other conditions like amyloidosis.
• Timely bronchoscopic intervention is critical for managing severe RP exacerbations.

Purpose of the Study:

• To report a case of relapsing polychondritis (RP) with severe respiratory distress.
• To evaluate the efficacy of combined bronchoscopic intervention, including laser tracheobronchoplasty and glucocorticoids (GCs) spraying, in managing RP onset.
• To highlight the diagnostic challenges and therapeutic strategies for RP-induced airway compromise.

Main Methods:

• A 56-year-old male with a 2-year history of recurrent dyspnea was diagnosed with RP based on clinical signs, CT scans, and endoscopic findings.
• Initial treatment included noninvasive ventilation, budesonide, glucocorticoids (GCs), and moxifloxacin.
• Emergency bronchoscopy with laser tracheobronchoplasty and GCs spraying was performed due to worsening respiratory distress, followed by cyclophosphamide administration.

Main Results:

• The patient experienced significant relief from dyspnea post-intervention.
• No recurrence of symptoms was observed within one month of treatment completion.
• The combined bronchoscopic approach demonstrated efficacy in stabilizing the patient's condition.

Conclusions:

• Distinguishing RP from other causes of respiratory distress based solely on CT scans can be difficult, especially when infection exacerbates RP.
• Endoscopic diagnosis and intervention are crucial when pathological results are delayed.
• Early laser tracheobronchoplasty and GCs spraying during bronchoscopy are recommended for managing acute respiratory distress in RP.