Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea, chronic non-productive cough, and inspiratory stridor. History significant for recurrent episodes of auricular and nasal chondritis. Symptoms exacerbated by exertion, suggestive of tracheobronchial malacia and subglottic stenosis. No history of smoking or occupational inhalational exposure.
Clinical Examination Findings
HEENT: Erythematous, swollen pinnae with sparing of the lobules; saddle-nose deformity noted. Respiratory: Audible stridor on auscultation, diminished breath sounds at bases, prolonged expiratory phase. Cardiovascular: Regular rate and rhythm, no murmurs. Skin: No active vasculitic lesions.
Treatment Protocol
Initiate systemic corticosteroid therapy (prednisone 1mg/kg/day) with tapering schedule. Consider steroid-sparing agents (methotrexate or azathioprine) for refractory disease. Airway management: Urgent pulmonology/ENT consultation for bronchoscopy and assessment for airway stenting or surgical reconstruction if severe stenosis is present.