Laryngeal papilloma presenting as steroid-dependent asthma in a 3-year-old child without recurrent stridor

Area of Science:

• Pediatric Pulmonology
• Otolaryngology
• Pediatric Respiratory Diseases

Background:

• Upper airway obstruction is a known mimic of asthma, particularly challenging to diagnose in pediatric patients.
• Recurrent wheezing in children often leads to asthma diagnoses, but other conditions can present similarly.

Observation:

• A 3-year-old boy experienced a year of severe, intractable wheezing, unresponsive to standard asthma treatments, with marked nasal obstruction but no typical croup or stridor.
• Initial examination revealed clear lungs, but imaging suggested a subglottic mass.

Findings:

• Bronchoscopy identified a solitary laryngeal papilloma as the cause of the subglottic obstruction.
• Surgical excision of the papilloma resulted in complete resolution of the wheezing symptoms.

Implications:

• Laryngeal papillomatosis should be considered in the differential diagnosis of pediatric patients, especially those aged 2-4 years, presenting with recurrent, therapy-resistant wheezing.
• The absence of hoarseness, croup, or stridor does not exclude laryngeal papillomatosis in young children with apparent asthma.
• This case underscores the importance of thorough diagnostic evaluation for persistent respiratory symptoms in children to identify rare underlying causes.