[A patient with Lesch-Nyhan syndrome complicated by tracheobronchomalacia and fatal bleeding from tracheobrachiocephalic artery fistula].

A 19-year-old man with Lesch-Nyhan syndrome (LNS), had dyspnea and an inspiratory wheeze, and underwent assisted mechanical ventilation and tracheostomy. Bronchoscopy revealed tracheomalacia of the cresent moon type. He lost his weight, and his general condition gradually worsened. Four months post-tracheostomy, he died of massive hemoptysis from a tracheobrachicephalic artery fistula. Many patients with LNS have renal failure and pneumonitis, whereas occasional cases are complicated by convulsions, recurrent coma, abnormalities of respiration, and sudden death. The etiology of sudden death is not clear. Although tracheomalacia, to our knowledge, has not been described in the literature, it may be a clinical feature of LNS associated with abnormal respiration and sudden death. Tracheobrachiocephalic artery fistula is common in patients with neuromuscular disorders and a chronic tracheostomy tube. Caution is required in LNS patients with opisthotonic extensor spasms of the neck and trunk, chronic bronchitis, and malnutrition.