A Man With A History of Vasculitis and Wheezing

Case Puzzler | 01.01.10

A 27-year-old man was diagnosed with Wegener granulomatosis (WG) and treated with corticosteroids and cytotoxic agents. Remission was induced, and all medications were eventually discontinued. The patient returned for his semiannual follow-up visit 1 year later, complaining of wheezing and shortness of breath. Physical examination and radiograph did not reveal recurrence of the disease, but wheezing was heard over the chest and neck. A flow volume loop maneuver was performed:

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The flow volume loop shows flattening of the inspiratory and expiratory loops, consistent with fixed airway obstruction. This complication occurs in up to 25% of patients with WG, most often in the subglottic area and usually independent of other manifestations of this disease. Subglottic obstruction was confirmed by bronchoscopy, and the patient underwent successful laser surgery with relief of symptoms. Prompt recognition of this complication of WG by a simple flow-volume loop leads to rapid treatment and alleviates the need for unnecessary work up.

Submitted by:
Subani Chandra, MD and Rubin Cohen, MD,
Airways Disorders Steering Committee Member

A Man With A History of Vasculitis and Wheezing

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