# A 28-Year-Old Man with Stridor and Dyspnea

## TL;DR

A 28-year-old man with tracheobronchial stenosis due to GPA was successfully treated with a combination of bronchoscopy and immunosuppressive therapy.

## Contribution

This case highlights the importance of combined systemic and endoscopic therapies for GPA-associated tracheobronchial stenosis.

## Key findings

- Multidisciplinary management improved airway obstruction significantly.
- The patient remained in remission for two years post-treatment.
- Tracheobronchial stenosis is a severe and debilitating manifestation of GPA.

## Abstract

Background: Tracheobronchial stenosis is a significant complication in granulomatosis with polyangiitis (GPA), a systemic vasculitis that primarily affects the upper respiratory tract, kidneys, and lungs. The involvement of the tracheobronchial tree in GPA leads to airway narrowing, which can result in severe respiratory symptoms and increased morbidity, often requiring prompt diagnosis and management to prevent life-threatening airway obstruction. Method: We present the case of a 28-year-old male with mild exertional dyspnea, stridor, and retropharyngeal sputum. Clinical investigations revealed subglottic and bronchial concentric stenosis with granulomatous inflammation. A diagnosis of granulomatosis with polyangiitis (GPA) with isolated tracheobronchial stenosis (TBS) was confirmed. Results: Given the severity of airway obstruction, multidisciplinary management was initiated, combining rigid bronchoscopy with systemic immunosuppressive therapy. Post-intervention follow-up demonstrated significant airway improvement and maintained remission after two years. Conclusions: This case highlights TBS as a potentially debilitating GPA manifestation requiring a combination of systemic and endoscopic therapies. Further studies are needed to optimize therapeutic approaches and improve outcomes in GPA-associated TBS.