Abstract Introduction Tracheal stenosis is a rare but serious complication often resulting from prolonged intubation, autoimmune diseases, or infections. In immunocompromised patients, such as those undergoing chimeric antigen receptor T-cell (CAR-T) therapy, opportunistic infections like fungal tracheitis can contribute to airway narrowing. This case highlights an incidental discovery of severe tracheal stenosis secondary to fungal tracheitis in such a patient, emphasizing the importance of prompt bronchoscopic intervention and targeted antifungal therapy. Case Description A 78-year-old female with a history of multiple myeloma treated with CAR-T therapy, chronic kidney disease, and coronary artery disease who presented with diarrheal illness. Computed tomography (CT) incidentally revealed tracheal stenosis. Upon further inquiry, she reported a mild cough for 3 months and progressively worsening shortness of breath for 2 months. She denied prior history of airway narrowing, autoimmune conditions, or recent intubation; her last intubation occurred 9 years prior during an orthopedic procedure. Bronchoscopy demonstrated a mid-tracheal lesion occluding 90% of the airway lumen, with a bridge of thick granulation tissue forming a tracheal web. Biopsies were obtained, followed by cryotherapy, laser coagulation for hemostasis, and balloon dilation. Bronchoalveolar lavage (BAL) grew extended-spectrum beta-lactamase (ESBL)-producing Klebsiella, treated with ertapenem. Pathology from tracheal biopsies showed benign partially devitalized cartilage with reactive squamous mucosa, detached fungal elements, necrotic cartilage with fungal hyphae, and bacteria, consistent with tracheitis. Subsequent bronchoscopies with dilations confirmed ongoing tracheitis, suspected to be fungal in etiology. The patient was initiated on isavuconazole for presumed fungal tracheitis contributing to the stenosis. Her symptoms improved with serial interventions and antifungal therapy. Discussion This case is novel in illustrating tracheal stenosis as an incidental finding in a CAR-T-treated multiple myeloma patient, likely driven by fungal tracheitis in an immunocompromised state. CAR-T therapy’s profound immunosuppression predisposes patients to opportunistic infections, but fungal tracheitis as a cause of stenosis is underreported. Early bronchoscopic diagnosis, multimodal therapy (cryotherapy, laser, dilation), and targeted antimicrobials were crucial in this case. Fungal tracheitis can affect immune compromised patients and lead to significant airway obstruction. It is important for clinicians to consider this diagnosis in immune compromised patients with subacute dyspnea and cough. This abstract is funded by: None
Genz et al. (Fri,) studied this question.