Clinical case report: intralesional corticosteroid application in recurrent tracheal stenosis

Abstract

BACKGROUND: Benign tracheal stenosis in adults has three etiologies: secondary to prolonged intubation, idiopathic, and rheumatologic. The one associated with prolonged intubation has been described as a lesion due to the persistent pressure of the balloon on the tracheal mucosa, which predisposes to a regional hyperinflammatory response; for that reason, modulating treatments for this response have been proposed as an alternative to classical surgical treatment. To date there is no treatment defined as Gold-Standard; both open and endoscopic treatments are practiced, among the last described, an option is intralesional corticosteroids injection. CASE REPORT: This is a 47-year-old woman with a history of prolonged mechanical ventilation; months later she was diagnosed with tracheal stenosis, initial treated with dilation and stent placement, with subsequent complications (stent migration, reinterventions due to respiratory distress). The patient sought medical attention due to dyspnea, stridor, productive cough, halitosis and general malaise, finding severe tracheal stenosis (98%) by flexible fiberoptic bronchoscopy. EVOLUTION: Using rigid bronchoscopy, the stent was removed, dilation was performed, and we administered intralesional corticosteroid for one time, with a good immediate response; in addition, a course of intramuscular corticosteroids was administered for two days. Six months after the procedure, the patient remained without recurrences, with a stable tracheal stenosis of 30%. CONCLUSION: After the bibliographic review carried out, as well as the successful experience we had with the patient, we agree with the available literature that this new treatment option is adequate for its application, although we recognize that larger studies are required to define the precise indications and an optimal protocol for its establishment.