Bronchoscopy-Guided Intervention Therapy With Extracorporeal Membrane Oxygenation Support for Relapsing Polychondritis With Severe Tracheobronchomalacia: A Case Report and Literature Review

Abstract

Relapsing polychondritis is an immune disorder of unknown etiology involving multiple systems that is characterized by persistent inflammation and destruction of cartilage, including the ears, nose, costal, joint, and airways. Airway involvement caused by relapsing polychondritis is common, and tracheobronchomalacia is the most serious complication, which is life-threatening. Currently, the exact mechanism of relapsing polychondritis with tracheobronchomalacia is unknown. Although glucocorticoids and immunosuppressive agents are administered, failures often occur. Currently, bronchoscopy-guided intervention therapy used in tracheobronchomalacia caused by chronic obstructive pulmonary disease or other etiology has gradually increased, but bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation assist used in tracheobronchomalacia caused by relapsing polychondritis has not been reported. Here, we report a case of relapsing polychondritis with severe tracheobronchomalacia. Although drug therapy was provided and airway stent implantation was performed, the tracheal stenosis was further aggravated. Because conventional anesthesia and mechanical ventilation cannot meet the needs of bronchoscopy-guided intervention therapy or guarantee sufficient safety. The intervention treatment was performed with the support of extracorporeal membrane oxygenation, which was successfully completed without obvious complications. The symptoms were significantly improved, and the patient was discharged uneventfully.

Relapsing polychondritis with isolated tracheobronchial involvement complicated with Sjogren's syndrome: A case report

“…Although patients with severe tracheobronchomalacia can be successfully treated with bronchoscopy-guided intervention therapy[ 31 ], we have doubts about the efficacy of the treatment in those patients who have, like ours, pathological laryngopharyngeal reflux. Our patient is currently stable, reports a high quality of life, and is under long-term follow-up to monitor treatment efficacy.…”

Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report

“…Sometimes, regional anesthesia is used to avoid difficulties surrounding airway management [ 10 ]. When general anesthesia is necessary, cautious airway management is needed [ 11 ], or an oxygen supply should be guaranteed by extracorporeal membrane oxygenation [ 12 ]. During general anesthesia, respiratory insufficiency associated with dynamic hyperinflation or difficult extubation have been reported [ 13 , 14 ].…”

Relapsing Polychondritis with Tracheobronchial Involvement: A Detailed Description of Two Pediatric Cases and Review of the Literature

“…Interventional airway management is the mainstay of non-pharmacologic treatment. These include endoscopic stenting, balloon dilatation of the airway, tracheostomy, endobronchial laser therapy, and laryngotracheal reconstruction 51 . Cartilage deformities can be corrected by plastic surgery improving overall quality of life 52 53 .…”