28190872 Visualization

A 37 Age - year Age - old Age African Personal_background American Personal_background female Sex with a past medical history significant for stage History 1 History sarcoidosis Disease_disorder presented Clinical_event to our facility Nonbiological_location with a chief complaint of shortness Sign_symptom of Sign_symptom breath Sign_symptom .
Ten Date years Date prior Date , she presented Clinical_event with bilateral Detailed_description uveitis Disease_disorder and lupus Sign_symptom pernio Sign_symptom ( LP Sign_symptom ) on her right Biological_structure ear Biological_structure and was subsequently diagnosed with sarcoidosis Disease_disorder .
She was successfully Lab_value treated Therapeutic_procedure for these conditions and her sarcoidosis Disease_disorder remained quiescent Lab_value until three Date years Date ago Date , when, at an outside Nonbiological_location institution Nonbiological_location , she was discovered Clinical_event to have laryngeal Biological_structure involvement Sign_symptom .
She was treated Therapeutic_procedure with prednisone Medication 60 Dosage mg Dosage daily Dosage for several Duration months Duration and eventually Date tapered to 10 Dosage mg Dosage daily Dosage .
Her sarcoidosis Disease_disorder remained well Lab_value - controlled Lab_value on this maintenance Dosage dose Dosage of prednisone Medication until six Date months Date prior Date , at which time she self Lab_value - discontinued Lab_value her prednisone Medication in favor of the homeopathic Therapeutic_procedure treatment Therapeutic_procedure Nopalea Medication cactus Medication juice Medication , which unsubstantially claimed to have anti-inflammatory properties [4].
Subsequently, she developed dyspnea Sign_symptom on Detailed_description exertion Detailed_description progressing to dyspnea Sign_symptom at Detailed_description rest Detailed_description .
During this time her voice Activity became increasingly hoarse Sign_symptom and she experienced frequent Frequency episodes of difficulty Sign_symptom swallowing Sign_symptom .
In our emergency Nonbiological_location department Nonbiological_location , her physical Diagnostic_procedure examination Diagnostic_procedure was concerning for respiratory Sign_symptom distress Sign_symptom as she presented with inspiratory Sign_symptom stridor Sign_symptom and hoarseness Sign_symptom .
She also had chronic Lab_value - appearing Lab_value , indurated Lab_value lesions Sign_symptom on her right Biological_structure ear Biological_structure .
Given that she had signs of upper Disease_disorder airway Disease_disorder disease Disease_disorder for impending Lab_value respiratory Disease_disorder failure Disease_disorder , an emergent Detailed_description bedside Detailed_description laryngoscopy Diagnostic_procedure was performed, revealing an obstructed Disease_disorder airway Biological_structure with the epiglottis Biological_structure retroflexed Sign_symptom over the glottis Biological_structure and significant Lab_value edema Sign_symptom in the arytenoids Biological_structure and aryepiglottic Biological_structure folds Biological_structure .
She was immediately treated with high Dosage - dose Dosage intravenous Administration dexamethasone Medication and taken Clinical_event emergently to the operating Nonbiological_location room Nonbiological_location ( OR Nonbiological_location ) to secure Therapeutic_procedure her airway Biological_structure for concern for complete Lab_value upper Biological_structure airway Biological_structure obstruction Disease_disorder , which was confirmed with direct Diagnostic_procedure visualization Diagnostic_procedure of her larynx Biological_structure in the OR Nonbiological_location .
She was intubated Therapeutic_procedure for a surgical Therapeutic_procedure airway Therapeutic_procedure , and after taking biopsies Diagnostic_procedure from the lingual Biological_structure surface Biological_structure of her epiglottis Biological_structure , a #4 Detailed_description cuffed Detailed_description Shiley Detailed_description ™ tracheostomy Therapeutic_procedure was placed.
Her respiratory Diagnostic_procedure status Diagnostic_procedure immediately stabilized Lab_value , was extubated Therapeutic_procedure , and transferred Clinical_event to our medical Nonbiological_location intensive Nonbiological_location care Nonbiological_location unit Nonbiological_location .
Her tracheostomy Therapeutic_procedure was exchanged to a #4 Detailed_description cuffless Detailed_description Shiley Detailed_description on postoperative day Date 5 Date .
During this time she was transitioned from intravenous Administration dexamethasone Medication to prednisone Medication 60 Dosage mg Dosage daily Dosage .
Biopsies Diagnostic_procedure ultimately revealed non Detailed_description - necrotizing Detailed_description epithelioid Detailed_description granulomas Sign_symptom consistent with sarcoidosis Disease_disorder (Figure 1).
She was prescribed this high Dosage - dose Dosage prednisone Medication for three Duration months Duration , and after receiving education Clinical_event for self Therapeutic_procedure - tracheostomy Therapeutic_procedure care Therapeutic_procedure , she was discharged Clinical_event home Nonbiological_location .
At her subsequent one Date - month Date and three Date - month Date follow Clinical_event - up Clinical_event visits, she denied any further respiratory Sign_symptom issues Sign_symptom .
Repeat laryngoscopies Diagnostic_procedure showed significant improvement Lab_value in the edema Sign_symptom in the arytenoids Biological_structure and aryepiglottic Biological_structure folds Biological_structure , but the epiglottis Biological_structure continued to obscure Disease_disorder the glottis Biological_structure despite therapy with high Dosage - dose Dosage prednisone Medication .
Methotrexate Medication was initiated while prednisone Medication was tapered to 10 Dosage mg Dosage daily Dosage ; however, this regimen failed and her prednisone Medication dosage was increased to 20 Dosage mg Dosage daily Dosage to reduce edema.
Because she declined surgical Therapeutic_procedure treatment Therapeutic_procedure , she will continue with medical Therapeutic_procedure management Therapeutic_procedure with immunosuppressive Therapeutic_procedure therapy Therapeutic_procedure to facilitate eventual de-cannulation.