title: Upper Airway Obstruction Requiring Emergent Tracheostomy Secondary to Laryngeal Sarcoidosis: A Case Report.
abstract: BACKGROUND Laryngeal sarcoidosis is a rare extrapulmonary manifestation of sarcoidosis, accounting for 0.33-2.1% of cases. A life-threatening complication of laryngeal sarcoidosis is upper airway obstruction. In this report we describe our experience in the acute and chronic care of a patient who required an emergent tracheostomy, with the aim to provide further insight into this difficult to manage disease. CASE REPORT A 37-year-old African American female with a 10-year history of stage 1 sarcoidosis presented with severe dyspnea. Laryngeal sarcoidosis was diagnosed three years previously, and she remained stable on low-dose prednisone until six months prior to admission, at which time she self-discontinued her prednisone for the homeopathic treatment Nopalea cactus juice. Her physical examination was concerning for impending respiratory failure as she presented with inspiratory stridor and hoarseness. Laryngoscopy showed a retroflexed epiglottis obstructing the glottis with edematous arytenoids and aryepiglottic folds. Otolaryngology performed an emergent tracheostomy to secure her airway and obtained epiglottic biopsies, which were consistent with sarcoidosis. She was eventually discharged home on prednisone 60 mg daily. Following months of corticosteroids, a laryngoscopy showed the epiglottis continuing to obstruct the glottis. The addition of methotrexate to a tapered dosage of prednisone 10 mg daily was unsuccessful, and she remains on prednisone 20 mg daily for disease control. CONCLUSIONS Laryngeal sarcoidosis, a rare extrapulmonary manifestation of sarcoidosis, uncommonly presents as the life-threatening complication of complete upper airway obstruction. As such, laryngeal sarcoidosis is associated with significant morbidity and mortality, requiring a high index of suspicion for timely diagnosis and treatment.
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Changwan
authors.initials: C
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Herzog
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Hongyi
authors.initials: H
authors.lastname: Pan
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Homer
authors.affiliation: Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Mridu
authors.initials: M
authors.lastname: Gulati
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D007828:Laryngoscopy; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011241:Prednisone