Abstract
A 23-year-old female patient presented with complaints of stridor and dyspnea. Around September 1988, the patient had begun to have cough, sputum and discomfort in the chest region. She received outpatient treatment in a hospital in her neighborhood, but the treatment did not relieved the symptoms, the patient was admitted to our hospital on November 21, 1988. Ordinary treatment for asthma and antibiotic therapy failed to prove effective. At the otorhinological department, tracheal obstruction immediately below the vocal cord was noted : Upon tracheal tomography, the symptoms were diagnosed as upper tracheal obstruction, for which tracheotomy was performed. Respiratory sounds of the left lung were not audible. Chest tomograms, chest CT and bronchofiberscopy revealed edematous changes in the entire tracheobronchial tree and with edematous obstruction of the left main bronchus. One week after the patient received 50mg oral predonine (PD), bronchofiberscopy was performed. Although edematous changes were still noted in the entire tracheobronchoial tree, the left main bronchus was found to be patent. Biopsy showed only inflammatory and reactive changes without any specific findings. Following PD dosage reduction to 30mg, the trancheobroncial lesion relapsed, complicated by bilateral auricular chondritis and keratoconjunctivitis. At that time, a diagnosis of relapsing polychondritis was made. Increase of PD dosage to 60mg produced relief of the symptoms. At present, the patient is on 40mg PD therapy and is recovering smoothly. We report this case of relapsing polychondritis which was difficult to diagnose and treat.
