Unusual cause of respiratory distress misdiagnosed as refractory asthma

We report a young lady, who was labeled as a case of refractory asthma for a few years, based on history of shortness of breath on minimal exertion, noisy breathing and normal chest radiograph. Repeated upper airway exam by an otolaryngologist and computerized tomography scan, were normal. On presentation to our hospital, she was diagnosed to have fixed upper airway obstruction, based on classical flow-volume loop findings. Fibroptic bronchoscopy revealed a web-shaped subglottic stenosis. The histopathology of a biopsy taken from that area, showed non-specific inflammation. No cause for this stenosis could be identified. The patient was managed with rigid bronchoscopy dilatation, without recurrence. We report this case as idiopathic subglottic stenosis, that was misdiagnosed as refractory bronchial asthma, stressing the importance of performing spirometry in the clinic. ubglottic stenosis is a serious and sometimes S life- threatening condition. It results from narrowing of the subglottic airway, which is housed in the cricoid cartilage. It is the narrowest area of the airway, since it is a complete, non expandable and a non pliable ring. Stenosis in this area can be congenital, which is usually diagnosed during childhood, or acquired. Typically, acquired subglottic stenosis has an insidious onset, where early manifestations are usually mistaken for other respiratory disorders, like bronchial asthma and bronchitis. We report a patient with acquired subglottic stenosis of unknown etiology. She was misdiagnosed as a case of refractory bronchial asthma for few years, until her condition was finally diagnosed with the help of spirometry and fibroptic bronchoscopy. Successful dilatation was performed with rigid bronchoscope, without recurrence. Case Report