[A case of relapsing polychondritis with oculobulbar symptoms and successful treatment of respiratory failure with BiPAP].
A 66-year-old man developed diplopia, ptosis, dysphagia, and acute respiratory failure. The initial diagnosis was myasthenia gravis and prednisolone had been administrated for three years. Because of recurrent upper respiratory infections, prednisolone was tapered off. Two months later, auricular chondritis, arthritis, and conjunctivitis appeared. He was diagnosed as having relapsing polychondritis on the basis of histological findings of the ear lobe biopsy. Reinstituted prednisolone had the effect on the auricular chondritis, arthritis, and conjunctivitis, but no effect on dysphagia, hoarseness, and respiratory failure caused by the deformity of the pharynx and airway. Tracheal collapse usually causes rapid death, so early tracheostomy and the use of endotracheal prostheses have been recommended in patients with airway obstruction from relapsing polychondritis, but such surgical management can only partially open up the large airways and has no effect on smaller airways. In this case tracheostomy and endoluminal stent placement have helped improve the patient's respiratory failure, but have had little effect on its aggravation at night in the supine position. The use of BiPAP after surgical management can be an effective treatment for airway involvement in relapsing polychondritis probably because it keeps the narrowed airways from collapsing, especially at night.
Ishikawa
S
S
Department of Neurology, Nagano Red-Cross Hospital.
Yamazaki
M
M
Takei
Y
Y
Miyazaki
A
A
Hanyu
N
N
D000208:Acute Disease; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001763:Blepharoptosis / Q000209:etiology*; D003680:Deglutition Disorders / Q000209:etiology; D004172:Diplopia / Q000209:etiology*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D011081:Polychondritis, Relapsing / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D015607:Stents; D014139:Tracheostomy
D000893:Anti-Inflammatory Agents; D011239:Prednisolone