The Important Role of Endoscopy in Management of Pediatric Pseudomembranous Necrotizing Tracheitis

Wu, Xiling; Wu, Lei; Chen, Zhimin

doi:10.3389/fped.2020.00360

Cited by 2 publications

(2 citation statements)

References 20 publications

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Section: Discussionmentioning

confidence: 99%

“…12 Interestingly in the pediatric population, necrotizing tracheitis appears to be commonly caused by a superimposed infection of Influenza A and Staphylococcus aureus. 13 Non-infectious causes of necrotizing tracheitis that have been reported include endotracheal intubation and inflammatory bowel disease. [14][15][16] Necrotizing tracheitis causes persistent airway inflammation and tissue friability, increasing the risk for emergent complications such as airway obstruction and tracheal perforation, both of which were seen in this case.…”

Section: Discussionmentioning

confidence: 99%

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Necrotizing Tracheitis Complicated by Tracheal Wall Perforation

et al. 2022

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Necrotizing tracheitis is a rare condition, mainly seen in immunocompromised patients, that may lead to pseudomembrane formation, airway obstruction and in severe cases, tracheal perforation. We present a case of a 32-year-old male with poorly controlled diabetes who presented with productive cough, dysphagia, and respiratory distress. Bronchoscopy revealed extensive tracheal necrosis along a 4-5 cm segment of cartilaginous trachea and was complicated by tracheal perforation with false passage into the anterior mediastinum. Once the airway was re-established, a multidisciplinary team discussed options for definitive airway management, including tracheal reconstruction, pulmonary stent, or tracheostomy. Ultimately, a distal XLT tracheostomy was placed. Microbiology specimens of the tracheal tissue were positive for Actinomyces. The patient was started on long-term antibiotics and diabetes management. At three-month follow-up, the trachea was patent with near complete mucosalization of the previously necrotic segment. An area of proximal tracheal stenosis was successfully managed with a customized tracheal T-tube. In conclusion, this is a case of necrotizing tracheitis complicated by tracheal perforation. Successful treatment required a multidisciplinary team for airway management as well as medical treatment of immunocompromising risk factors and antimicrobial therapy. This enabled timely healing of the trachea and a durable airway.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Necrotizing Tracheitis Complicated by Tracheal Wall Perforation

et al. 2022

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Pseudomembranous necrotizing laryngotracheobronchitis due to Mycoplasma pneumoniae: a case report and literature review

Zhang

Chen

et al. 2022

BMC Infect Dis

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Background Pseudomembranous necrotizing laryngotracheobronchitis refers to an acute diffuse necrotizing inflammation in the mucosa of the larynx, trachea, and bronchus. It often occurs in infants and children having viral infections secondary to bacterial infections. Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen that causes pneumonia in children. In recent years, serious complications due to M. pneumoniae infection, including necrotizing pneumonia, pulmonary embolism, and pleural effusion, have been increasingly reported. Case presentation An 11-year-old girl was admitted to our unit with cough, fever, and hoarseness persistent for a week. The results of the M. pneumoniae serological test, PCR examination with bronchial aspirate and bronchoalveolar lavage fluid (BALF), next-generation sequencing (mNGS) for BALF, all suggested the presence of M. pneumoniae infection. High-resolution CT scanning of the chest showed inflammation of the middle and lower lobes of the right lung. By bronchoscopy, the necrosis of the vocal cords, trachea, and bronchial mucosa was observed; each bronchial lumen contained a large amount of white viscous sputum. Pathological findings for bronchial mucosa suggested inflammatory necrosis. After administration of azithromycin and glucocorticoids, the symptoms of the patients were ameliorated. After 2 weeks post-discharge, the X-ray scan of her chest indicated the pneumonia resolution in the right lung. Conclusions In patients with pneumonia due to M. pneumoniae infection, which causes obvious hoarseness, bronchoscopy is necessary even if the lung lesions are not massively consolidated. When necrotizing lesions of the larynx, trachea, and bronchi are detected by bronchoscopy, the necrotic tissues in the corresponding parts should be conducted tissue biopsy for pathological examination. Apart from macrolide antibiotics, the administration of small doses of glucocorticoids is necessary.

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The Important Role of Endoscopy in Management of Pediatric Pseudomembranous Necrotizing Tracheitis

Cited by 2 publications

References 20 publications

Necrotizing Tracheitis Complicated by Tracheal Wall Perforation

Necrotizing Tracheitis Complicated by Tracheal Wall Perforation

Pseudomembranous necrotizing laryngotracheobronchitis due to Mycoplasma pneumoniae: a case report and literature review

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