Tracheal adenoid cystic carcinoma masquerading as refractory asthma

Adenoid cystic carcinoma (ACC) of the trachea is a rare tumor that often presents with nonspecific respiratory symptoms, leading to misdiagnosis. Its slow-growing yet locally invasive nature allows it to mimic common airway diseases such as asthma, resulting in delayed diagnosis and treatment. We report the case of a 46-year-old woman with a 2-year history of progressive dyspnea and wheezing, initially diagnosed and treated as bronchial asthma. Despite adherence to guideline-directed therapy, her symptoms worsened, prompting further evaluation. Physical examination revealed stridor and diffuse rhonchi. Imaging and bronchoscopy identified a posterior tracheal wall mass, confirmed by histopathology and immunohistochemistry to be ACC. The patient underwent tumor debulking and tracheal stenting via rigid bronchoscopy, followed by chemotherapy with paclitaxel and carboplatin. She has shown clinical improvement and remains under follow-up. This case highlights the diagnostic challenge posed by tracheal ACC masquerading as refractory asthma. Clinicians should maintain a high index of suspicion for structural airway lesions in patients with atypical or unresponsive asthma symptoms. Early recognition and a multidisciplinary approach are essential to improve outcomes in such rare but serious conditions.