Primary tracheal papillomatosis presenting as reactive airway disease

Typically patients with recurrent respiratory papillomatosis (RRP) initially manifest laryngeal disease with symptoms of hoarseness, weak cry, and stridor. Extralaryngeal spread is not uncommon, and distal progression may be facilitated by airway epithelial injury, inducing squamous metaplasia. Kashima et al1 found laryngeal papilloma in 97.9% of 417 patients with RRP, but tracheal papilloma only when there was a positive history of tracheostomy. Indeed the diagnosis of RRP may be delayed, as its clinical features often resemble those of more common respiratory disorders.2 We present an 11-year-old boy with no history or evidence of laryngeal papillomata who nevertheless was discovered to have extensive tracheal papillomas.