Department of Otolaryngology, 8784University of California San Diego, La Jolla, CA, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, 8784University of California San Diego, La Jolla, CA, USA.
Ear Nose Throat J. 2022 Dec;101(10_suppl):26S-29S. doi: 10.1177/01455613221123664. Epub 2022 Aug 26.
Necrotizing tracheitis is a rare condition, mainly seen in immunocompromised patients, that may lead to pseudomembrane formation, airway obstruction and in severe cases, tracheal perforation. We present a case of a 32-year-old male with poorly controlled diabetes who presented with productive cough, dysphagia, and respiratory distress. Bronchoscopy revealed extensive tracheal necrosis along a 4-5 cm segment of cartilaginous trachea and was complicated by tracheal perforation with false passage into the anterior mediastinum. Once the airway was re-established, a multidisciplinary team discussed options for definitive airway management, including tracheal reconstruction, pulmonary stent, or tracheostomy. Ultimately, a distal XLT tracheostomy was placed. Microbiology specimens of the tracheal tissue were positive for . The patient was started on long-term antibiotics and diabetes management. At three-month follow-up, the trachea was patent with near complete mucosalization of the previously necrotic segment. An area of proximal tracheal stenosis was successfully managed with a customized tracheal T-tube. In conclusion, this is a case of necrotizing tracheitis complicated by tracheal perforation. Successful treatment required a multidisciplinary team for airway management as well as medical treatment of immunocompromising risk factors and antimicrobial therapy. This enabled timely healing of the trachea and a durable airway.
坏死性气管炎是一种罕见的疾病，主要见于免疫功能低下的患者，可能导致假膜形成、气道阻塞，在严重的情况下，还会导致气管穿孔。我们报告了一例 32 岁的男性患者，患有未得到良好控制的糖尿病，表现为咳痰、吞咽困难和呼吸窘迫。支气管镜检查显示广泛的气管坏死，累及软骨气管的 4-5cm 段，并伴有气管穿孔，假道通向前纵隔。一旦气道重建，多学科团队就会讨论明确的气道管理选择，包括气管重建、肺支架或气管切开术。最终，进行了远端 XLT 气管切开术。气管组织的微生物标本检测出阳性。患者开始接受长期抗生素和糖尿病管理。在三个月的随访中，气管通畅，先前坏死段的黏膜几乎完全再生。近端气管狭窄的区域通过定制的气管 T 型管成功得到了处理。总之，这是一例坏死性气管炎并发气管穿孔的病例。成功的治疗需要多学科团队进行气道管理，以及针对免疫抑制危险因素的药物治疗和抗菌治疗。这使得气管能够及时愈合，并建立了一个持久的气道。
