Author(s)
Ryan J Lau, MD
Taylor G Lackey, Daniel Fink
Affiliation(s)
University of Colorado;
Abstract:
Objective: Nontuberculous mycobacteria (NTM) most commonly involves the pulmonary system, though prior studies have documented head and neck involvement. Patients with lung disease and immunosuppression are more susceptible to NTM infection. We present the first case of Mycobacterium abscessus (MABc) infection isolated to the subglottis and trachea.
Methods: Case report and review of the literature.
Results: A 68-year-old female with history of prior smoking, reflux disease, asthma, bronchiectasis, and tracheobronchomalacia initially presented for shortness of breath and voice changes. Office tracheoscopy demonstrated abnormal tissue with stenosis of the subglottis and upper trachea. The patient underwent direct microlaryngoscopy, bronchoscopy with biopsies and laser ablation of disease. Culture from OR revealed AFB positive for MABc. The patient was treated with an antimicrobial regimen of oral azithromycin, clofazimine, Diflucan and inhaled amikacin. The follow up procedure included biopsies and cultures with no growth and with patient’s airway well-healed.
Conclusion: NTM tracheitis is an exceedingly rare condition causing inflammation and progressive airway compromise as seen in this patient with subglottic stenosis. The patient’s history of bronchiectasis and subsequent NTM infection is consistent with known risk factors for NTM infection. Patients with risk factors for NTM infection and concern for laryngotracheal involvement should have direct laryngoscopy with biopsy and culture and may be successfully treated with endoscopic ablation and appropriate antimicrobials.