Bronchoscopy-Guided Intervention Therapy With Extracorporeal Membrane Oxygenation Support for Relapsing Polychondritis With Severe Tracheobronchomalacia: A Case Report and Literature Review

Bing Fu,Pengcheng Zhou,Wei Yu,Chuantao Zhang,Keling Chen,Wenhui Huang,Wenjun Tang,Qianming Xia

doi:10.3389/fmed.2021.695505

Abstract

Relapsing polychondritis is an immune disorder of unknown etiology involving multiple systems that is characterized by persistent inflammation and destruction of cartilage, including the ears, nose, costal, joint, and airways. Airway involvement caused by relapsing polychondritis is common, and tracheobronchomalacia is the most serious complication, which is life-threatening. Currently, the exact mechanism of relapsing polychondritis with tracheobronchomalacia is unknown. Although glucocorticoids and immunosuppressive agents are administered, failures often occur. Currently, bronchoscopy-guided intervention therapy used in tracheobronchomalacia caused by chronic obstructive pulmonary disease or other etiology has gradually increased, but bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation assist used in tracheobronchomalacia caused by relapsing polychondritis has not been reported. Here, we report a case of relapsing polychondritis with severe tracheobronchomalacia. Although drug therapy was provided and airway stent implantation was performed, the tracheal stenosis was further aggravated. Because conventional anesthesia and mechanical ventilation cannot meet the needs of bronchoscopy-guided intervention therapy or guarantee sufficient safety. The intervention treatment was performed with the support of extracorporeal membrane oxygenation, which was successfully completed without obvious complications. The symptoms were significantly improved, and the patient was discharged uneventfully.

Highlights

Relapsing polychondritis (RP) is a rare immune disorder involving multiple systems, in which the cartilage is the main target organ
RP is an immune disorder with an unknown etiology and multiple-system involvement
The results showed that bleeding was the most common complication of extracorporeal membrane oxygenation (ECMO), with a prevalence rate of 27%, and the overall prevalence of thromboembolic events was 8%

Summary

INTRODUCTION

Relapsing polychondritis (RP) is a rare immune disorder involving multiple systems, in which the cartilage is the main target organ. Bronchoscopy showed that the mucosa of the trachea and main bronchi were severely hyperemic and swollen, and the cartilage had disappeared (Figures 3A–G). Bronchoscopy showed that the lumen of the subglottis to the upper segment of the tracheal stent was narrow, the mucosa was severely swollen, cartilage had disappeared, and granulation hyperplasia was present (Figures 3H–L). Improved after bronchoscopy-guided argon plasma coagulation, and CO2 cryoablation was performed, which significantly relieved the patient’s symptoms (Figures 3M–P). Emergency chest CT and bronchoscopy showed granulation hyperplasia and scar tissue in the lumen of the subglottis to the upper segment of the tracheal stent, hyperemia and swelling of the mucosa, and a large amount of thick sputum blockage in the lumen, resulting in severe narrowing of the lumen (Figures 2R, 3Q).

DISCUSSION

CONCLUSION

Findings

ETHICS STATEMENT