SESSION TITLE: Procedures in Chest Infections Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: Bacterial tracheitis is a post-viral superimposed bacterial infection associated with the pediatric population. It is a rare phenomenon in adults with the first incidence reported in 1988. We report a case of bacterial tracheitis as a post-intubation complication in a patient who presented with progressive dyspnea.CASE PRESENTATION: A 61-year-old male with cirrhosis presented to the hospital with progressive dyspnea, myalgias and malaise. He was in acute rehab when he desaturated to 88%. On evaluation, there was new tongue swelling and dyspnea exertion. On examination, vitals were: blood pressure 106/84, pulse 115, temperature 99.1 °F, respiratory rate 15 and SaO2 100% on 2L nasal cannula. He had mild work of breathing and an audible stridor. A venous blood gas was notable for pH of 7.38, PCO2 of 33, bicarbonate of 20. A rapid influenza A was positive. His stridor worsened while in the ED; further investigation with computed tomography (CT) neck with contrast was showed 50% tracheal narrowing of the upper thoracic trachea (Figure 1). Of note, he had been hospitalized a month prior in an outside hospital requiring intubation for 6 days. He was started on oral steroids. Pulmonology evaluated him with a fiberoptic bronchoscopy and found evidence of sub-glottic tracheal inflammation with exudate and severe tracheal narrowing (Figure 2). The area of inflammation was deemed to be where the cuff of the endotracheal tube likely resided during prior intubation. Broad spectrum antibiotics were initiated. Bronchial washing resulted grew Klebsiella pneumoniae and Haemophilus parainfluenzae. On day 4, the stridor resolved and was started on oral antibiotics. On discharge, he was to continue antibiotics for 4 weeks and repeat CT Neck for infection resolution before discontinuing antibiotic therapy.DISCUSSION: The pathophysiology of bacterial tracheitis involves a post-viral bacterial superinfection leading to rapidly progressive stridor due to upper airway obstruction by tracheal secretions and inflammation (1). The most common bacteria are Staphylococcus aureus and Streptococcus pneumoniae (2). Early diagnosis is imperative to prevent mortality from tracheal obstruction (3). Bronchoscopy allows direct visualization, opportunity to biopsy and culture (1). Treatment includes careful airway monitoring and broad-spectrum antimicrobial therapy covering as gram negative and atypical bacteria (2). In our patient, the etiology is a post-intubation complication coupled with recent viral illness. During hospitalization, he remained on room air managed with broad spectrum antimicrobial therapy and steroids. His stridor improved and was able to be discharged with an oral antibiotic and pulmonology follow up.CONCLUSIONS: Bacterial tracheitis, a rare cause of airway obstruction in adults requires early bronchoscopic evaluation and appropriate antibiotic therapy to decrease mortality from respiratory arrest.Reference #1: Valor, Raul R., et al. "Bacterial tracheitis with upper airway obstruction in a patient with the acquired immunodeficiency syndrome." American Review of Respiratory Disease 146 (1992): 1598-1598Reference #2: Stuchell, Bryan, Ann Chinnis, and Stephen Davis. "Case report: bacterial tracheitis in an adult female." The West Virginia Medical Journal 99.4 (2003): 154-155.Reference #3: Johnson, Jonas T., and Stephen L. Liston. "Bacterial tracheitis in adults." Archives of Otolaryngology–Head & Neck Surgery 113.2 (1987): 204-205.DISCLOSURES: No relevant relationships by Kofi AnsahNo relevant relationships by Jeffrey BloomerNo relevant relationships by Emmanuel CommeyNo relevant relationships by Ghazi KhanNo relevant relationships by DAVID MURILLO SESSION TITLE: Procedures in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Bacterial tracheitis is a post-viral superimposed bacterial infection associated with the pediatric population. It is a rare phenomenon in adults with the first incidence reported in 1988. We report a case of bacterial tracheitis as a post-intubation complication in a patient who presented with progressive dyspnea. CASE PRESENTATION: A 61-year-old male with cirrhosis presented to the hospital with progressive dyspnea, myalgias and malaise. He was in acute rehab when he desaturated to 88%. On evaluation, there was new tongue swelling and dyspnea exertion. On examination, vitals were: blood pressure 106/84, pulse 115, temperature 99.1 °F, respiratory rate 15 and SaO2 100% on 2L nasal cannula. He had mild work of breathing and an audible stridor. A venous blood gas was notable for pH of 7.38, PCO2 of 33, bicarbonate of 20. A rapid influenza A was positive. His stridor worsened while in the ED; further investigation with computed tomography (CT) neck with contrast was showed 50% tracheal narrowing of the upper thoracic trachea (Figure 1). Of note, he had been hospitalized a month prior in an outside hospital requiring intubation for 6 days. He was started on oral steroids. Pulmonology evaluated him with a fiberoptic bronchoscopy and found evidence of sub-glottic tracheal inflammation with exudate and severe tracheal narrowing (Figure 2). The area of inflammation was deemed to be where the cuff of the endotracheal tube likely resided during prior intubation. Broad spectrum antibiotics were initiated. Bronchial washing resulted grew Klebsiella pneumoniae and Haemophilus parainfluenzae. On day 4, the stridor resolved and was started on oral antibiotics. On discharge, he was to continue antibiotics for 4 weeks and repeat CT Neck for infection resolution before discontinuing antibiotic therapy. DISCUSSION: The pathophysiology of bacterial tracheitis involves a post-viral bacterial superinfection leading to rapidly progressive stridor due to upper airway obstruction by tracheal secretions and inflammation (1). The most common bacteria are Staphylococcus aureus and Streptococcus pneumoniae (2). Early diagnosis is imperative to prevent mortality from tracheal obstruction (3). Bronchoscopy allows direct visualization, opportunity to biopsy and culture (1). Treatment includes careful airway monitoring and broad-spectrum antimicrobial therapy covering as gram negative and atypical bacteria (2). In our patient, the etiology is a post-intubation complication coupled with recent viral illness. During hospitalization, he remained on room air managed with broad spectrum antimicrobial therapy and steroids. His stridor improved and was able to be discharged with an oral antibiotic and pulmonology follow up. CONCLUSIONS: Bacterial tracheitis, a rare cause of airway obstruction in adults requires early bronchoscopic evaluation and appropriate antibiotic therapy to decrease mortality from respiratory arrest. Reference #1: Valor, Raul R., et al. "Bacterial tracheitis with upper airway obstruction in a patient with the acquired immunodeficiency syndrome." American Review of Respiratory Disease 146 (1992): 1598-1598 Reference #2: Stuchell, Bryan, Ann Chinnis, and Stephen Davis. "Case report: bacterial tracheitis in an adult female." The West Virginia Medical Journal 99.4 (2003): 154-155. Reference #3: Johnson, Jonas T., and Stephen L. Liston. "Bacterial tracheitis in adults." Archives of Otolaryngology–Head & Neck Surgery 113.2 (1987): 204-205. DISCLOSURES: No relevant relationships by Kofi Ansah No relevant relationships by Jeffrey Bloomer No relevant relationships by Emmanuel Commey No relevant relationships by Ghazi Khan No relevant relationships by DAVID MURILLO