Recurrent Idiopathic Subglottic Stenosis in Multiple Pregnancies: A Case Report
Introduction: Idiopathic subglottic stenosis (ISS) is a type of central airway obstruction primarily affecting adult Caucasian females. Its rarity and similar clinical presentation to asthma contribute to its frequent misdiagnosis. Timely treatment of ISS is crucial for pregnant patients who are at risk for emergent surgeries necessitating ventilation and intubation. Case: A 29-year-old, previously healthy female reported new onset dyspnea on exertion and a dry, non-productive cough to her family physician. Clinical exam was unremarkable; however, pulmonary function testing revealed a moderate, fixed airway obstruction. Endoscopy visualized subglottic stenosis 1.7 cmdistal to her vocal cords and surgical intervention using CO2 laser dilatation was scheduled with Otolaryngology. However, the patient received a positive pregnancy test prior to her elective surgery dateand after consideration of risks and benefits to mother and fetus, the surgery was postponed to her second trimester. Unfortunately, the patient miscarried her fetus and was scheduled for an emergent dilatation and curettage (D&C). She was successfully bag-mask ventilated during the D&C and subsequently underwent surgery for ISS with full resolution of her symptoms. In subsequent follow-up, the patient reported a return of dyspnea coinciding with another positive pregnancy test. ISS recurrence was diagnosed; however, as symptoms were mild, a repeat surgery was postponed until the patient safely delivered her child. Discussion: This case illustrates the difficulties in the diagnosis and management of ISS in pregnant patients during their childbearing years as surgical intervention will impact both the mother and fetus.