Laryngeal manifestations of microscopic polyangiitis in a pediatric patient: a case report

Abstract

Microscopic polyangiitis is a rare small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies. Otorhinolaryngological manifestations are uncommon, par- ticularly in pediatric patients, which may delay diagnosis and appropriate treatment. We report the case of a 16 year- old female with a history of Graves disease on methi- mazole who presented to the emergency department with nonspecific otorhinolaryn- gological symptoms, followed by rapid clinical deterioration that required advanced resuscitation and admission to the pediatric intensive care unit. Clinical evaluation revealed epiglottic edema, yellowish lesions on the oropharyngeal mucosa, and right vocal fold paralysis. Laboratory findings demonstrated positive anti-myeloperoxidase antibodies, confirming the diagnosis of microscopic polyangiitis. The patient received two cycles of rituximab with marked clinical improvement and preserved vocal fold mobility. This case underscores the diagnostic challenge of microscopic polyangiitis with initial laryngeal involvement in a pediatric patient and highlights the importance of close observation and an interdisciplinary approach.