Zhou Pengcheng, Fu Bing, Zhang Chuantao, Chen Keling, Xia Qianming, Tang Wenjun, Yu Wei, Huang Wenhui
Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Department of Cardiothoracic Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Med (Lausanne). 2021 Nov 23;8:695505. doi: 10.3389/fmed.2021.695505. eCollection 2021.
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.
复发性多软骨炎是一种病因不明的累及多个系统的免疫性疾病，其特征为包括耳、鼻、肋、关节及气道等部位的软骨持续发生炎症和破坏。复发性多软骨炎所致的气道受累较为常见，气管支气管软化是最严重的并发症，可危及生命。目前，复发性多软骨炎合并气管支气管软化的确切机制尚不清楚。尽管应用了糖皮质激素和免疫抑制剂，但治疗失败仍屡见不鲜。目前，用于慢性阻塞性肺疾病或其他病因所致气管支气管软化的支气管镜引导下介入治疗逐渐增多，但复发性多软骨炎所致气管支气管软化应用体外膜肺氧合辅助的支气管镜引导下介入治疗尚未见报道。在此，我们报告1例复发性多软骨炎合并严重气管支气管软化的病例。尽管给予了药物治疗并实施了气道支架植入术，但气管狭窄仍进一步加重。由于传统麻醉和机械通气无法满足支气管镜引导下介入治疗的需求或保证足够的安全性。在体外膜肺氧合支持下进行了介入治疗，成功完成且无明显并发症。症状明显改善，患者顺利出院。
