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A 20-month-old girl presented to a paediatric emergency department with a short history of cough, coryza, diarrhoea and vomiting.
She developed severe respiratory distress with biphasic stridor, tripod posturing and drowsiness. Oxygen saturations were 85%. Epinephrine nebulisers and oral dexamethasone were administered. She initially improved but had further sudden deterioration with persistent soft stridor and respiratory distress. She had noisy breathing since birth (but no hoarse voice) and recurrent ‘croup’. There was no history of foreign body inhalation. Recent ear, nose and throat (ENT) outpatient review had been unremarkable and she was discharged after an acceptable overnight oxygen sleep study.
Due to the unusual presentation, ENT visualised her airway. On microlaryngobronchoscopy, respiratory papillomas were found. There was ‘no discernible airway’ with a papilloma arising from a right false cord and ventricle, completely obstructing the airway (see figure 1). The obstructing papillomas were removed (see figure 2) and sent for histology. She was discharged home the next day.
Recurrent respiratory papillomatosis (RRP) was diagnosed.1 RRP is caused by human papillomavirus (HPV 6/11) and treatment is surgical removal (the papillomas usually regrow), there is no medical cure.2 The interval between surgery is unpredictable. She continues to need repeated resection of the papillomas every 1–2 months. She has not had further acute admissions for respiratory distress.
RRP is rare (see table 1) but should be considered in children presenting with acute-onset severe stridor, particularly with a history of noisy breathing/hoarseness. Upper airway endoscopy is diagnostic.
Patient consent for publication
Contributors EP drafted the article. CLD, AK and AJD reviewed and revised the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.