PMC9434006_01
Trachea at start of macrolide-therapy: Thick fibrous strands and marked stenosis.
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F1
Bronchoscopy revealed progressive scars, constriction of the trachea (Figure 1) as well as chronic mucosal changes of both main and lingula bronchi, with stromal inflammation and epithelial metaplasia, establishing the diagnosis of iSGS.
After 1 year of macrolide-therapy: Circular deformed, non-stenotic trachea with considerably diminished scar formation.
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F2
After 12 months of treatment, histology and endoscopy of the tracheal mucosa showed an increased inflammatory pattern with a normal tracheal diameter (Figure 2). AZT was increased to 3 x 500 mg/week and pantoprazole was added for 4 weeks, again without any positive effect on coughing. AZT was exchanged for roxithromycin 300 mg every other day, because of the probable better anti-inflammatory properties with a lesser dose given.