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Laryngotracheobronchial papillomatosis: an uncommon cause of recurrent respiratory infection

An 11-year-old female patient presented with chronic cough and recurrent respiratory infection, without other associated comorbidities. Laboratory test results were unremarkable. Chest computed tomography showed multiple cavitated nodules in both lungs lungs (Figure 1). Bronchoscopy revealed small nodular lesions in the trachea; histopathological analysis confirmed diagnosis of laryngotracheobronchial papillomatosis (LP).

FIGURE 1:
Chest computed tomography showing multiple cavitated nodules scattered throughout both lungs (A-C), with no evidence of calcification (D).

LP, caused by human papillomavirus, is characterized by the appearance of papillomas in the aerodigestive tract, with pulmonary involvement in ~ 1% of cases11. Fortes HR, Ranke FMV, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol. 2017;43(4):259-63. doi: 10.1590/S1806-37562016000000351
https://doi.org/10.1590/S1806-3756201600...
,22. Marchiori E, Araujo Neto Cd, Meirelles GS, Irion KL, Zanetti G, Missrie I, et al. Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest. J Bras Pneumol . 2008;34(12):1084-9. doi: 10.1590/s1806-37132008001200016
https://doi.org/10.1590/s1806-3713200800...
,33. Carifi M, Napolitano D, Morandi M, Dall’Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag. 2015;11:731-8. doi: 10.2147/TCRM.S81825.
https://doi.org/10.2147/TCRM.S81825...
. Infection commonly occurs at birth, by passing through the infected mother’s birth canal11. Fortes HR, Ranke FMV, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol. 2017;43(4):259-63. doi: 10.1590/S1806-37562016000000351
https://doi.org/10.1590/S1806-3756201600...
,22. Marchiori E, Araujo Neto Cd, Meirelles GS, Irion KL, Zanetti G, Missrie I, et al. Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest. J Bras Pneumol . 2008;34(12):1084-9. doi: 10.1590/s1806-37132008001200016
https://doi.org/10.1590/s1806-3713200800...
,33. Carifi M, Napolitano D, Morandi M, Dall’Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag. 2015;11:731-8. doi: 10.2147/TCRM.S81825.
https://doi.org/10.2147/TCRM.S81825...
. The main clinical manifestations are hoarseness, cough, stridor, dyspnea, and recurrent infection. The course of the disease is unpredictable, ranging from spontaneous remission to pulmonary dissemination requiring multiple surgical interventions, and malignant transformation to squamous cell carcinoma of the lung11. Fortes HR, Ranke FMV, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol. 2017;43(4):259-63. doi: 10.1590/S1806-37562016000000351
https://doi.org/10.1590/S1806-3756201600...
,22. Marchiori E, Araujo Neto Cd, Meirelles GS, Irion KL, Zanetti G, Missrie I, et al. Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest. J Bras Pneumol . 2008;34(12):1084-9. doi: 10.1590/s1806-37132008001200016
https://doi.org/10.1590/s1806-3713200800...
,33. Carifi M, Napolitano D, Morandi M, Dall’Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag. 2015;11:731-8. doi: 10.2147/TCRM.S81825.
https://doi.org/10.2147/TCRM.S81825...
. Although this diagnosis may be suggested by clinical and radiological findings, final diagnosis is made by histopathological analysis.

ACKNOWLEDGMENTS

We thank the institutions that provided technical support for developing and implementing this study.

REFERENCES

  • 1
    Fortes HR, Ranke FMV, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol. 2017;43(4):259-63. doi: 10.1590/S1806-37562016000000351
    » https://doi.org/10.1590/S1806-37562016000000351
  • 2
    Marchiori E, Araujo Neto Cd, Meirelles GS, Irion KL, Zanetti G, Missrie I, et al. Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest. J Bras Pneumol . 2008;34(12):1084-9. doi: 10.1590/s1806-37132008001200016
    » https://doi.org/10.1590/s1806-37132008001200016
  • 3
    Carifi M, Napolitano D, Morandi M, Dall’Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag. 2015;11:731-8. doi: 10.2147/TCRM.S81825.
    » https://doi.org/10.2147/TCRM.S81825

Publication Dates

  • Publication in this collection
    27 Jan 2020
  • Date of issue
    2020

History

  • Received
    20 Sept 2019
  • Accepted
    14 Nov 2019
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