Abstract
Introduction: Lye (sodium hydroxide or potassium hydroxide) is a strong alkali that can cause caustic burns upon ingestion. We describe a unique patient with lye-associated tracheal stenosis who underwent LT evaluation at our center. Description: A 41-year-old woman with a history of bronchiectasis was referred to our center for lung transplant evaluation. At the time of presentation, she was tracheostomized (uncuffed Shiley 6.0), on room air at baseline, and had a gastrojejunal (GJ) tube. She had a history of intentional lye ingestion with Pop Rocks at age 16. Subsequently, she had endured a supraglottic tear that was deemed irreparable at the time. She was tracheostomized and underwent several tracheal dilations for tracheal stenosis. She also developed esophageal stenosis and needed a GJ tube. The patient had also experienced episodes of recurrent infection and aspiration events leading to further airway damage. On initial consultation, the patient was independent at baseline and walked 453 meters in 6 minutes with lowest oxygen saturation of 90%. Bronchoscopy demonstrated tracheitis with plaques (image), and imaging demonstrated bronchiectasis with patent tracheobronchial tree; cultures grew Pseudomonas aeruginosa. Given no recent exacerbations and an acceptable quality of life, she was deemed too early for transplant consideration and referred to the Pulmonary Clinic. Discussion: Our case illustrates the relationship between severe airway damage from lye ingestion and the potential for lung transplantation. The pathophysiology of lye injury is secondary to saponification of the chemical resulting in tissue necrosis, cellular damage, and deep, extensive burns leading to fibrosis and scarring resulting in tracheal and esophageal injury. Mediastinal fibrosis may pose a higher surgical risk. While lung transplantation remains a potential option, careful consideration of the extent of airway damage, the patient's overall nutritional status, infection control, and pulmonary function is paramount to optimizing outcomes.