Otolaryngology (ENT) performed direct laryngoscopy and bronchoscopy but was complicated by the need to place a tracheostomy for airway protection. Biopsy of tracheal cartilage showed disruption and fibrosis involving the tracheal cartilage consistent with relapsing polychondritis.

Collagen II antibodies are neither sensitive nor specific for relapsing polychondritis. The upper and lower airways should be evaluated, including by direct laryngoscopy, complete spirometric testing, expiratory chest CT, and bronchoscopy if airway involvement is suspected.

Relapsing polychondritis is a rare multisystem disease characterized by recurrent inflammation of cartilaginous structures in the body. It can also affect other proteoglycan-rich structures 1. The condition is extremely rare with an estimated incidence of ~1 in 285,000.

During her hospitalization, various diagnostic tests were performed including a laryngoscopy which demonstrated decreased vocal cord mobility and subglottic stenosis secondary to an inflamed and swollen mucosa. A bacterial infection was suspected and antibiotic therapy with ampicillin/sulbactam and erythromycin was initiated.

Relapsing polychondritis (RP) is a rare autoimmune condition which presents as recurrent episodes of cartilaginous inflammation of the auricular, nasal and tracheal cartilage. Jaksh-Wartenhorst described the first case in 1923.