A rare cause of respiratory distress in preterm infants: a case report of acquired subglottic cysts

Abstract

Background The SGCs are a rare cause of respiratory distress in infants. Typical risk factors include male gender, extreme prematurity, gastro-oesophageal reflux and mechanic intubation, the latter being associated with mucosal damage and blockage of the subglottic cysts’ ducts. We described a case of acquired subglottic cysts in a premature infants presented with respiratory distress Case presentation: A premature male infant was born at 25 + 2 weeks of gestation age with a history of monochorionic twin diamniotic pregnancy with twin-to-twin transfusion syndrome. During hospitalization invasive mechanical ventilation was necessary for a total of 18 days; the patient was discharged at 40 w + 1 days in good condition. After 3 weeks he presented to our department with mixed stridor and worsening of respiratory dynamics. A laryngotracheoscopy evaluation was performed. The exam showed the presence of multiple glottic-subglottic cysts (SGCs) causing a complete obstruction of the airway. The histopathology confirmed the benign nature of the lesions. Because of the significant reduction of the airway’s patency, he was submitted to tracheotomy and thereafter to cysts’ removal using cold steel microinstruments. A better airway patency was restored although a slight glottic edema persisted. Conclusion In conclusion, SGCs should be considered in preterm infants previously intubated with respiratory distress, which cannot be explained by the most common causes. Early diagnosis and treatment are fundamental to reducing the morbidity and mortality associated with this disease.