Introduction
Subglottic stenosis (SGS) is the commonest manifestation of
tracheobronchial disease in granulomatosis with polyangiitis (GPA)
(8-23% cases).1 The progression of the inflammatory
ring and fibrosis below the true vocal cords in GPA is dictated by the
number of relapses and vasculitic insult sustained. Early recognition
and management is imperative in limiting SGS in GPA (SGS-GPA), with
otolaryngologists often the first clinician to encounter the
disease.2
Management of SGS-GPA can be challenging as delayed treatment may cause
respiratory compromise, whilst aggressive surgery may trigger a systemic
inflammatory response and associated vasculitic
complications.3There are currently no guidelines for SGS-GPA management. Several
different surgical techniques described in the
literature,3 including subglottic dilatation with
pulmonary balloons, bougie, rigid bronchoscopy, laser and use of
intra-lesional steroid injections. 3,5 However, the
impact of systemic immunosuppression (IS) on SGS-GPA management and
deferring surgery has not been widely explored.
Our department adopted a combined medical and surgical approach,
consisting of subglottic dilatations with systemic steroids given at
induction of anaesthesia and systemic IS in the peri-operative period.
IS was administered with the view of suppressing any current or
potential inflammatory response from surgery.