Abstract
Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis that can involve the respiratory tract and lead to severe airway complications. We present a 61-year-old female with an undiagnosed GPA who experienced severe airway obstruction and rapid deterioration during a flexible bronchoscopy. Severe glottic edema and reduced vocal cord mobility resulted in a challenging airway and rapid desaturation, and ultimately led to cardiac arrest. This case highlights the importance of considering GPA in the differential diagnosis of patients with unexplained respiratory symptoms, even in the absence of classic clinical features. Early diagnosis, careful pre-procedural airway assessment, and experienced airway management are essential to minimize the risk of airway compromise in patients with suspected or confirmed GPA.