Author(s)
Melissa Papuc, BS
Manikandan Sugumaran, MD
Affiliation(s)
Arizona Otolaryngology Consultants;
Abstract:
Introduction: Intralesional steroid injections for idiopathic subglottic stenosis can improve patient quality of life, with minimal systemic absorption assumed. However, the impact on infection risk has not been quantified. Scedosporium apiospermum is a soil fungus known to cause respiratory infections. Although bronchial stenosis in association with Scedosporium apiospermum has been reported, it has not been described in tracheal or subglottic stenosis. We present the first case of an immunocompetent woman with idiopathic subglottic stenosis who developed Scedosporium apiospermum infection of the subglottis while receiving in-office steroid injections.
Methods: We reviewed the patient’s medical records from an ENT office to write this report. Case/
Results: An immunocompetent 67 year-old female with idiopathic subglottic stenosis was treated with intraluminal steroid injections every three-to-four months over two years with successful airway maintenance. However, she recently developed difficulty breathing and was found to have significant reduction of airway patency. Intraoperatively, signs of acute infection were discovered that grew Scedosporium apiospermum. Discussion: Protocols for in-office steroid injections vary with respect to dosing and timing. Long-term side effects such as localized or systemic immunosuppression are poorly studied. It is unclear whether this patient developed subglottic infection due to disease progression or if the patient’s frequent steroid injections induced a level of localized immunosuppression. This raises whether such outcomes should be considered when making decisions on the frequency of and indications for steroid injections for idiopathic subglottic stenosis.
Conclusion: Future research should be performed studying the effect of intralesional steroid injections on immunocompetency locally and systemically in order to guide treatment protocols.