June 6th, 2020

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Acute Exacerbation of Subglottic Stenosis in Pregnancy: A Case Report
Authors:  Tracy B. Grossman, M.D., M.Sc., Ashutosh Kacker, M.D., Eugene Shostak, M.D., and Inna V. Landres, M.D.
BACKGROUND: Granulomatosis with polyangiitis is a rare cause of subglottic stenosis, and there is limited literature on the evaluation condition when it occurs in pregnancy.

CASE: A 37-year-old woman, P1001, at 33 + 5 weeks’ gestation and with a history of subglottic stenosis and recently diagnosed influenza presented with respiratory distress. Bronchoscopy showed severe tracheobronchial inflammation with subglottic stenosis which necessitated insertion of a tracheostomy tube. The patient was treated with antivirals and steroids and underwent an uncomplicated cesarean delivery at 35+6 weeks’ gestation. The tracheostomy was removed shortly thereafter.

CONCLUSION: This case demonstrates that the respiratory status and airway patency of patients with subglottic stenosis is often significantly worsened in pregnancy. An inciting factor, such as an infection, may acutely provoke episodes of hypoxia, necessitating intubation or tracheostomy placement. A carefully timed delivery may be necessary if a pregnant patient with subglottic stenosis and respiratory compromise requiring tracheostomy placement is unable to receive optimal
treatment due to pregnancy.
Keywords:  bronchial asthma; bronchoscopy; granulomatosis with poly- angiitis; intubation, intratracheal; laryngostenosis; obstetric labor complications; pregnancy; pregnant women; respiratory system; subglottic stenosis; tracheostomy
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