Paratracheal phlegmon following in-office steroid injection for idiopathic subglottic stenosis

Abstract

Management options for the treatment of idiopathic subglottic stenosis (iSGS) are varied and range from conservative medical therapies to traditional endoscopic and open surgery. The introduction of in-office percutaneous steroid injections has provided an alternative to operative interventions for this challenging patient population; however, complications associated with its use are poorly documented and understood.We report the first known infectious complication following office-based percutaneous steroid injections for iSGS. A 42-year-old female with a five-year history of recurrent iSGS presented 8 weeks following a series of in-office, percutaneous steroid injections to her iSGS with left neck discomfort. Contrast-enhanced computed tomography (CT) imaging revealed phlegmonous changes of the left neck and superior mediastinum. Broad-spectrum antibiotics and intravenous dexamethasone were administered with rapid clinical improvement. Repeat CT 4 weeks after presentation demonstrated resolution of inflammatory changes.While in-office percutaneous steroid injections for iSGS are an effective adjunct to operative-based procedures, adverse sequelae remain possible. Infectious complications following percutaneous laryngeal and subglottic injections should be promptly recognized and managed with a tailored antibiotic and steroid regimen, surveillance imaging, and close follow up.