29 April 2024 : Case report
[In Press] Smoking-Associated Endotracheal Hair Growth: A Case Report on Tracheal Complications
Unusual clinical course, Challenging differential diagnosis, Rare disease
Paul Thöne 12ABCDEF, Roland Kropfmüller12BCD, Daniela Gompelmann3DEF, Bernd Lamprecht 12ADE, David Lang 12ABCDEFDOI: 10.12659/AJCR.943909
Am J Case Rep In Press; DOI: 10.12659/AJCR.943909
Available online: 2024-04-29, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Abstract
BACKGROUND
A 52-year-old male patient presented with symptoms of chronic cough and persistent tracheal irritation 26 years after surgical closure of a tracheostoma, supported by an autologous auricular cartilage graft and cutaneous transplant. At the initial clinical presentation, the patient was an active smoker, with a cumulative dose of 31 pack years.
CASE REPORT
Bronchoscopy revealed endotracheal hair growth and local inflammation at the graft site. Initial anti-inflammatory, antimycotic, and antibacterial therapy was administered, followed by endoscopic structure remodeling. There were multiple recurrences with similar symptoms, showing isolated hair growth, without inflammation. Annual endoscopic restructuring sessions were indicated, and the patient experienced them as highly relieving. Recurrent hair growth was finally terminated by argon plasma laser-coagulation and after smoking cessation. We hypothesize that the onset of hair growth was triggered by the patient’s cigarette smoking.
CONCLUSIONS
Endotracheal hair growth is a potential complication of autograft-supported tracheal restructuring. The initial administration of antimicrobial and anti-inflammatory medication, combined with endoscopic restructuring, could have contained the active inflammation; the application of argon plasma laser-coagulation finally stopped the hair growth. Smoking is associated with the upregulation of molecular signaling pathways in the respiratory epithelium, which can stimulate hair follicles, such as sonic hedgehog protein, WNT-1/β-catenin, and epidermal growth factor receptor.
Keywords: Ear Cartilage; Endoscopy; Tracheotomy; Wnt Signaling Pathway; EGFR protein, human; SHH Protein, Human
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