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.