A 2-year-old boy presented to the hospital with a history of increased work of breathing over the 1 month following an upper respiratory infection. His medical history was significant for palmoplantar callouses and painful subungual hypertrophy of the fingers and toes, for which he had undergone matricectomy. His mother and 3 older siblings also had subungual hypertrophy and palmoplantar hyperkeratosis and blisters. He was diagnosed as having croup at the emergency department. He had no dysphagia or odynophagia, but there was minimal improvement in stridor after a trial of vaporized epinephrine and albuterol. Subsequently, he was seen at the outpatient pulmonology clinic and received a flexible bronchoscopy. The pulmonologist noted obstructive glottic edema at the vocal cords with a pinpoint airway, prompting urgent consultation to the pediatric otolaryngology service.
Tran CM, Stark MW, Jeyakumar A. Acute Airway Obstruction. JAMA Otolaryngol Head Neck Surg. 2014;140(8):775-776. doi:10.1001/jamaoto.2014.1120