LARYNGEAL PAPILLOMA PRESENTING AS STEROID-DEPENDENT ASTHMA IN A 3-YEAR-OLD CHILD WITHOUT RECURRENT STRIDOR

Upper airway obstruction is well described as a cause of apparent asth ma. However, it can be very difficult to diagnose in young children. T his 3-year-old male presented with a 1-year history of severe recurren t wheezing with six emergency room visits in the previous 5 months. Cr omolyn, inhaled corticosteroids, and frequent predinisolone bursts had not controlled the wheezing. There was no history of barky cough, cro up, or strider. His physical examination was notable for marked nasal obstruction. Ar initial presentation, his lungs were normal with no wh eezing or strider. Soft tissue neck X-ray films suggested the presence of a subglottic mass. A large solitary papilloma was found on broncho scopy. After surgical removal, there was no further wheezing noted by either the parents or his physicians. Laryngeal papillomatosis may mim ic asthma in the absence of symptoms of hoarseness, croup, or strider It should be particularly considered in 2 to 4-year-old children with recurrent wheezing that is poorly responsive to aggressive therapy inc luding oral corticosteroids.