CRP1 UNUSUAL SUBGLOTTIC MASS IN A CHILD WITH AN AUTOINFLAMMATORY DISEASE

Qiao Yun Lee1, Chua Yi Cheau1, Nadia Fareeda Muhammad Gowdh3, Jeyasakthy Saniasiaya2, Jeyanthi A/P Kulasegarah2, Nurshadia Samingan1, Anna Marie Nathan1, Eg Kah Peng1, Jessie Anne de Bruyne1
1Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.
2Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia.
3Department of Biomedical Imaging, University Malaya, Kuala Lumpur, Malaysia.

Introduction:

Subglottic masses in children are rare and usually present with dynamic airway obstruction. These masses have a wide differential diagnosis, including congenital malformations, infections, hemangiomas, and neoplastic masses. These masses pose both a diagnostic and management challenge.

In this case report, we present an unusual case of a sizeable subglottic mass in an adolescent, causing acute life-threatening episodes, which was secondary to growth hormone therapy.

Case Report:

A 14-year-old boy with underlying chronic recurrent multifocal osteomyelitis presented with multiple episodes of acute breathing difficulty and cyanosis during sleep. This occurred after three months of initiating growth hormone (GH) therapy for GH deficiency secondary to prolonged steroid use. Initial polysomnogram (PSG) before GH treatment showed mild obstructive sleep apnea. Bronchoscopy revealed a non-pulsative, smooth-surfaced mass at the posterior aspect, subchordal, subglottic region, with dynamic obstruction of at least 80% of the airway. The diagnosis of subglottic mass was confirmed via neck and chest CT and MRI. Biopsy and histopathological examination of the mass revealed a non-malignant inflammatory mass. The initial treatment was cessation of GH therapy and initiation of nocturnal CPAP. However, due to worsening symptoms during a COVID-19 infection, he ultimately required a tracheostomy, which resolved all his symptoms. Two years later, his upper airway obstruction has markedly reduced radiologically (MRI). He is symptomatically ready for tracheostomy decannulation.

Conclusion:

Careful assessment and monitoring before and during GH therapy is essential as worsening upper airway obstruction during GH therapy can be potentially life-threatening. Fortunately, this is reversible.