Severe acute airway obstruction and respiratory failure with fibrous plug following photodynamic therapy (PDT): Indication for early bronchoscopy and debridement

IntroductionPDT is a safe procedure with most post procedural complications reported as minor. We report a case of severe acute stridor and trachea-bronchial airway obstruction with mucosal sloughing and fibrous plugs resulting in respiratory failure within three hours following PDT. To our knowledge this is the first reported case where stridor and acute respiratory failure resulted within hours following PDT treatment.Case ReportA 65 year old female with previous right pneumonectomy presented with followup bronchoscopy confirming reoccurrence of carcinoma proximal and distal to the anastomosis. A standard photofrin (Porfimer sodium) was administered at 2mg/kg body weight 48 hours prior to her PDT treatment. Three hours following the procedure, patient become acutely stridurous and was subsequently intubated. Bedside bronchoscopy was performed through the endotracheal tube. During the bronchoscopy thick tracheal plugs were retrieved and slough adjacent to the treatment site was noticed which was debrided. Patient underwent 7 bronchoscopies with debridement before she was discharged.ConclusionAirway obstruction (with NSCLA) is an indication as well as complication (with mucosal debris) of PDT. FDA has advised bronchoscopy at 48-72 hours post procedure, however early intervention with bronchoscopy and debridement should be considered to relieve tracheal bronchial airway obstruction and removal of accessory debris and mucosal slough.