Nin Olga C, Hutnik Robert, Chheda Neil N, Hutchinson David
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, United States.
Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL 32610, United States.
World J Clin Cases. 2024 May 6;12(13):2263-2268. doi: 10.12998/wjcc.v12.i13.2263.
There is limited literature on managing the airway of patients with linear immunoglobulin A (IgA) bullous dermatosis, a rare mucocutaneous disorder that leads to the development of friable bullae. Careful clinical decision making is necessary when there is a risk of bleeding into the airway, and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios, especially when confronted with an unusual cause for bleeding.
A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis. The diagnosis of IgA dermatosis was recent, and the patient had been lost to follow-up. The severity of the disease and extent of airway involvement was unknown at the time of the surgery. Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room. The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case. The patient was extubated on postoperative day 4.
A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure. In our case, key communication between the surgery, anesthesia, and dermatology teams led to the quick and safe treatment of our patient's disease. Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.
关于线状免疫球蛋白A（IgA）大疱性皮肤病患者气道管理的文献有限，这是一种罕见的黏膜皮肤疾病，可导致形成易碎的水疱。当存在气道出血风险时，谨慎的临床决策是必要的，多学科团队方法可能会降低这些高风险情况下患者的发病率，尤其是在面对不寻常的出血原因时。
一名45岁非裔美国女性因线状IgA大疱性皮肤病导致瘢痕性结膜炎和弥漫性角膜新生血管形成，钝性外伤后角膜穿孔，到我们的门诊手术中心进行右眼角膜移植。IgA皮肤病的诊断是最近做出的，患者失访了。手术时疾病的严重程度和气道受累程度尚不清楚。插管时发现大量气道出血，不得不将耳鼻喉科团队叫到手术室。患者需要转至重症监护病房，多学科团队参与了她的病例治疗。患者术后第4天拔管。
在手术前，采用多学科方法治疗这种疾病是最佳行动方案。在我们的病例中，手术、麻醉和皮肤科团队之间的关键沟通导致了对患者疾病的快速安全治疗。除非这些病例完全缓解且无黏膜受累，否则不应考虑进行门诊手术。
