Nin OC, Hutnik R, Chheda NN, Hutchinson D. Airway management of a patient with linear immunoglobulin A bullous dermatosis: A case report. World J Clin Cases 2024; 12(13): 2263-2268 [PMID: 38808340 DOI: 10.12998/wjcc.v12.i13.2263]
Corresponding Author of This Article
Olga C Nin, MD, Associate Professor, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States. onin@anest.ufl.edu
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2024; 12(13): 2263-2268 Published online May 6, 2024. doi: 10.12998/wjcc.v12.i13.2263
Airway management of a patient with linear immunoglobulin A bullous dermatosis: A case report
Olga C Nin, Robert Hutnik, Neil N Chheda, David Hutchinson
Olga C Nin, Robert Hutnik, David Hutchinson, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, United States
Neil N Chheda, Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL 32610, United States
Author contributions: Chheda NN and Hutchinson D critically reviewed and revised the manuscript; Nin OC wrote the original draft and critically reviewed and revised the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Olga C Nin, MD, Associate Professor, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States. onin@anest.ufl.edu
Received: December 19, 2023 Peer-review started: December 19, 2023 First decision: January 10, 2024 Revised: January 24, 2024 Accepted: March 26, 2024 Article in press: March 26, 2024 Published online: May 6, 2024 Processing time: 127 Days and 12.9 Hours
Abstract
BACKGROUND
There is limited literature on managing the airway of patients with linear immunoglobulin A (IgA) bullous dermatosis, a rare mucocutaneous disorder that leads to the development of friable bullae. Careful clinical decision making is necessary when there is a risk of bleeding into the airway, and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios, especially when confronted with an unusual cause for bleeding.
CASE SUMMARY
A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis. The diagnosis of IgA dermatosis was recent, and the patient had been lost to follow-up. The severity of the disease and extent of airway involvement was unknown at the time of the surgery. Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room. The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case. The patient was extubated on postoperative day 4.
CONCLUSION
A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure. In our case, key communication between the surgery, anesthesia, and dermatology teams led to the quick and safe treatment of our patient’s disease. Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.
Core Tip: Linear immunoglobulin A bullous dermatosis, a rare mucocutaneous disorder, can lead to significant airway bleeding due to the presence of friable bullae. Airway emergencies in ambulatory surgical centers can be very high risk. A multidisciplinary discussion of the disease and patient optimization needs to be performed before the day of surgery. These cases should be treated in the inpatient setting where resources are most easily accessible, and an ear, nose, and throat team should be available.
