Beyond the wheeze: unveiling a rare diagnosis behind the asthma mask

A 64-year-old male presented with progressive breathlessness and wheezing, initially suspected to be worsening asthma. Inhaled therapies were commenced and further investigations were conducted, including CT thorax, bronchoscopy, pulmonary function tests and autoimmune screening. Imaging revealed tracheobronchomalacia and bronchoscopy confirmed a grossly abnormal endobronchial tree with appearances suggestive of relapsing polychondritis. A multidisciplinary discussion led to a diagnosis of tracheobronchomalacia secondary to relapsing polychondritis. Worsening symptoms of breathlessness led to commencement of corticosteroids, nocturnal non-invasive ventilation and immunosuppression with infliximab. Subsequent escalation of management included endobronchial stenting, argon laser therapy and adjustment of therapy to rituximab with the addition of intravenous immunoglobulins.Relapsing polychondritis is a rare inflammatory disease with airway involvement in up to 50% of cases. Respiratory symptoms may be the first sign, often misdiagnosed as asthma, delaying appropriate care. This case highlights the need for early recognition and treatment to prevent irreversible airway damage in relapsing polychondritis.