Department of Internal Medicine IV - Pulmonology, Kepler Universitätsklinikum, Linz, Austria.
Medical Faculty, Johannes Kepler University, Linz, Austria.
Am J Case Rep. 2024 Jun 18;25:e943909. doi: 10.12659/AJCR.943909.
BACKGROUND A 52-year-old male patient presented with symptoms of chronic cough and persistent tracheal irritation 26 years after surgical closure of a tracheostoma, supported by an autologous auricular cartilage graft and cutaneous transplant. At the initial clinical presentation, the patient was an active smoker, with a cumulative dose of 31 pack years. CASE REPORT Bronchoscopy revealed endotracheal hair growth and local inflammation at the graft site. Initial anti-inflammatory, antimycotic, and antibacterial therapy was administered, followed by endoscopic structure remodeling. There were multiple recurrences with similar symptoms, showing isolated hair growth, without inflammation. Annual endoscopic restructuring sessions were indicated, and the patient experienced them as highly relieving. Recurrent hair growth was finally terminated by argon plasma laser-coagulation and after smoking cessation. We hypothesize that the onset of hair growth was triggered by the patient's cigarette smoking. CONCLUSIONS Endotracheal hair growth is a potential complication of autograft-supported tracheal restructuring. The initial administration of antimicrobial and anti-inflammatory medication, combined with endoscopic restructuring, could have contained the active inflammation; the application of argon plasma laser-coagulation finally stopped the hair growth. Smoking is associated with the upregulation of molecular signaling pathways in the respiratory epithelium, which can stimulate hair follicles, such as sonic hedgehog protein, WNT-1/ß-catenin, and epidermal growth factor receptor.
一位 52 岁的男性患者在接受自体耳软骨移植物和皮片移植支持的气管造口术关闭 26 年后，出现慢性咳嗽和持续气管刺激症状。初次就诊时，患者为活跃吸烟者，累积吸烟量为 31 包年。
支气管镜检查显示气管内有毛发生长，移植物部位有局部炎症。初始给予抗炎、抗真菌和抗菌治疗，随后进行内镜下结构重塑。患者多次出现类似症状的复发，表现为孤立性毛发生长，无炎症。每年需进行内镜下结构重塑，患者认为这些治疗非常缓解症状。最终通过氩等离子体激光凝固和戒烟来终止复发性毛发生长。我们假设毛发生长的发生是由患者吸烟触发的。
气管内毛发生长是自体移植物支持的气管重建的潜在并发症。初始给予抗菌和抗炎药物治疗，结合内镜下结构重塑，可能有助于控制活动性炎症；氩等离子体激光凝固的应用最终阻止了毛发生长。吸烟与呼吸道上皮中分子信号通路的上调有关，这些信号通路可以刺激毛囊，如 sonic hedgehog 蛋白、WNT-1/β-catenin 和表皮生长因子受体。
