Subglottic stenosis in granulomatosis with polyangiitis: clinical, histopathological and therapeutic considerations with presentation of two cases.

Granulomatosis with polyangiitis (GPA), once known as Wegener's granulomatosis (WG), is an uncommon systemic vasculitic disorder characterized by inflammation of the vascular walls, particularly affecting the respiratory tract. One serious complication is subglottic stenosis (SGS), a narrowing of the airway just below the vocal cords. While uncommon, it can be life-threatening and may show up as stridor, dyspnea, or voice changes. Sometimes, it is the first or only sign that someone has GPA. Diagnosing this condition takes a combination of clinical evaluation, imaging, endoscopy, and blood tests for specific antibodies [anti-neutrophil cytoplasmic antibodies (ANCA)]. Tissue biopsy is especially valuable, it can confirm the diagnosis by showing the characteristic inflammation patterns, particularly when the disease presents in unusual ways. Treatment typically involves both systemic immunosuppressive medications and, when necessary, procedures to open up the narrowed airway. We present two cases of GPA-associated SGS that highlight how differently this condition can present, the challenges of managing a compromised airway, and the need for tailored treatment plans. These cases reinforce why early detection of airway involvement matters, why patients need careful long-term monitoring to watch for re-narrowing, and why a team-based approach across specialties leads to the best outcomes.