# Asphyxiation due to obstructive fibrinous tracheal pseudomembrane after closure of repeated tracheostomy in a case of von Recklinghausen disease

## TL;DR

A rare tracheal complication called obstructive fibrinous tracheal pseudomembrane caused sudden death in a man with von Recklinghausen disease after repeated tracheostomies.

## Contribution

Highlights OFTP as a potentially fatal, under-recognized complication following tracheostomy closure in high-risk patients.

## Key findings

- OFTP can develop silently after tracheostomy closure and lead to sudden death.
- CT imaging may not detect early OFTP, as shown by mild narrowing initially.
- Histopathology confirmed fibrinous exudate with neutrophilic infiltration consistent with OFTP.

## Abstract

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare but potentially fatal complication, most commonly reported after endotracheal intubation. Its occurrence following tracheostomy closure is poorly recognized.

We report a fatal case of OFTP in a 33-year-old man with von Recklinghausen disease who developed progressive airway obstruction following closure of a repeated tracheostomy. The patient had a history of multiple facial tumor resections requiring repeated tracheostomies due to orofacial deformities. After the eighth tracheostomy and successful tumor debulking, the tracheal cannula was removed on postoperative day 6. At that time, CT revealed only mild tracheal narrowing without intraluminal obstruction, and the patient remained asymptomatic. However, he was found in cardiopulmonary arrest on postoperative day 14. Postmortem CT showed near-complete tracheal obstruction and pulmonary edema. Autopsy confirmed a grayish-white pseudomembrane obstructing the tracheal lumen, with only a 2-mm residual gap. Histopathology revealed fibrinous exudate with neutrophilic infiltration, consistent with OFTP.

This case illustrates that OFTP can occur silently after tracheostomy closure and may lead to sudden death. Vigilant monitoring with CT or bronchoscopy should be considered in high-risk patients with repeated tracheal interventions.