Granuloma Following Tracheostomy Closure: An Overlooked Cause of Chronic Cough.

Tracheostomy is a life-saving procedure often performed in cases of airway obstruction, prolonged mechanical ventilation, or neurological conditions affecting respiratory function. Although decannulation is generally safe, delayed complications such as tracheal granulomas can occur and may present with nonspecific symptoms, leading to delays in diagnosis. This report describes the case of a 45-year-old previously healthy female who developed a persistent dry cough and positional shortness of breath six months after tracheostomy closure. The patient was initially admitted with bilateral vocal cord paralysis following SARS-CoV-2 infection, resulting in tracheostomy. After support treatment with corticosteroid therapy, decannulation was performed 28 days later. During follow-up, the patient developed a refractory dry cough that was worse in the supine position. CT scan revealed a round, polypoid lesion extending into the tracheal lumen above the carina. The lesion was identified as a tracheal granuloma and was successfully excised via bronchoscopy, resulting in complete symptom resolution. This case highlights the need to consider tracheal granuloma in patients presenting with persistent respiratory symptoms after tracheostomy decannulation. Early recognition, appropriate imaging, and timely intervention are crucial for symptom relief and prevention of further complications. Bronchoscopic excision remains a safe and effective treatment option.