Management of Subglottic Stenosis With Tracheostomy in a Surgical Candidate Patient With Granulomatosis With...

Granulomatosis with polyangiitis (GPA) is a rare disease of unknown aetiology with variable severity and a relapsing course. We report a case emphasizing the importance of the airway status and management of patients with a history of GPA. The patient was a candidate for emergency endoscopic sinus surgery and general anaesthesia to control bleeding. After induction of anaesthesia, the patient was placed under general anaesthesia for endoscopic sinus examination, and mask ventilation was initiated. On laryngoscopy, porous granulomatous tissue and a web-like membrane were observed in the subglottic area near the vocal cords, involving extensive portions of the glottis and subglottis. Consequently, endotracheal intubation was not attempted. Given the urgency of the surgery, an emergency tracheostomy was performed, followed by the planned procedure. Subglottic stenosis (SGS) is one of the most difficult-to-treat organ involvements in patients with GPA. Screening for respiratory distress should be done even in asymptomatic patients at the time of diagnosis of GPA. Early diagnosis and management of tracheobronchial involvement in GPA significantly improve the prognosis of patients.