Relapsing polychondritis restricted to respiratory tract
Imaging in Emergency and Critical Care Medicine

Relapsing polychondritis restricted to respiratory tract

Cheng Zhu1, Yuetian Yu2

1Department of Emergency, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200005, China; 2Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China

Contributions: (I) Conception and design: Y Yu; (II) Administrative support: None; (III) Provision of study materials or patients: Y Yu; (IV) Collection and assembly of data: C Zhu; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Yuetian Yu. Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China. Email: fishyyt@sina.com.

Received: 20 July 2018; Accepted: 31 July 2018; Published: 10 August 2018.

doi: 10.21037/jeccm.2018.07.02


A 38-year-old male was admitted to our emergency department duo to recurrent attacks of breathlessness and chest congestion for 1 year. His medical history included ocular inflammation and arthritis for 5 years. On physical examination, a hoarse voice was clearly heard and respiratory rate was 40 per minute. Tracheal stenosis with thickening wall of it could be found in chest CT scan (Figure 1A,B,C,D,E). Tracheal cartilage revealed disappeared through bronchoscopy (Figures 1F,G,S1). Relapsing polychondritis (RP) was diagnosed and 500 mg of methylprednisolone for 3 days followed by 40 mg of oral prednisone per day was prescripted. The patient has been in good health without a recurrence for 6 months.

Figure 1 Respiratory tract image. (A) 3D reconstruction of bronchial tree showed the tracheal stenosis; (B,C) airway stenosis in chest CT scan (red arrow); (D,E) tracheal wall was thick (red arrow); (F,G) tracheal cartilage could not be found through bronchoscopy.
Figure S1 Bronchoscopy image. (A) Trachea; (B) eminence; (C) eminence; (D) right middle lobe; (E) right upper lobe; (F) left bronchus; (G) left upper lobe; (H) left lower lobe.

RP is a rare autoimmune disease and only 10% of it can invade the respiratory tract. Any three of the following features including nonerosive seronegative inflammatory arthritis, ocular inflammation, nasal chondritis, bilateral auricular chondritis, audiovestibular damage or respiratory tract chondritis can establish the diagnosis. The prime treatment of RP is glucocorticoid therapy. Methylprednisolone initially loading dose (15 mg/kg/day) is often needed and oral glucocorticoid therapy (1 mg/kg/day) should be lasted for 3–4 weeks. Intubation or tracheotomy might be an alternative in case of emergency. If glucocorticoid therapy doesn’t work well, stent is another option.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Informed Consent: Consent was obtained for the use of information and images. The patient’s identity has been kept confidential.

doi: 10.21037/jeccm.2018.07.02
Cite this article as: Zhu C, Yu Y. Relapsing polychondritis restricted to respiratory tract. J Emerg Crit Care Med 2018;2:64.