SESSION TITLE: Infectious Disease Student/Resident Case Report Posters III
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Acute epiglottis is a supraglottic inflammation of the oropharynx that may lead to life-threatening airway obstruction. It is classically associated with H. influenzae serotype b (HiB) in children. With the advent of the HiB vaccine in 1985, pediatric cases have dramatically declined. We described a case of acute epiglotitis in an adult caused by H. influenzae serotype a.
CASE PRESENTATION: A 38-year-old woman with a history of untreated hepatitis C presented to the emergency department with two-day history of throat pain, difficulty swallowing, and breathing that acutely worsened over several hours. She also noted neck tenderness and swelling. Her children were acutely ill with upper respiratory symptoms several days prior to her symptoms. She also had dental work done two weeks prior. She was up-to-date with her HiB vaccine. She was afebrile and her vitals were unremarkable. She appeared in mild distress and her voice was weak. Exam showed bilateral neck swelling with marked tenderness on palpation. She had good dentition with no peritonsillar abscess, tongue edema. A lateral neck radiograph showed narrowing of the airway with a "thumb sign" as shown in the figure. Laryngoscopic examination demonstrated significant pooling of secretions with erythematous and enlarged epiglottis. The airway was significantly narrowed but patent. Laboratory studies were significant for mild leukocytosis. CT of the neck showed diffuse uniform swelling of the epiglottis with no evidence of deep neck abscess. She was admitted to the intensive care unit and underwent elective nasotracheal intubation. She was started on IV steroids, IV ampicillin/sulbactam. Rapid testing for Streptococcus group A was negative. Nasopharyngeal swab for influenza A and B, and RSV PCR were negative. She was clinically improving and was extubated 48 hours later. Blood cultures grew H.influenzae, beta-lactamase negative, serotype a. Throat culture was negative. HIV antibody screen and viral load were negative.
DISCUSSION: This case illustrates the importance of having high index suspicion of possible causes of acute epiglotitis in adults. H. influenzae remains the majority of causative organism in childhood cases of acute epiglotitis. It is however, still a highly potential causative organism in adult cases. Severe fatal cases caused by H.influenza type a in the form of meningitis, pneumonia, and sepsis have been reported, particularly in those with compromised immune system or age greater than 50 years old. Comprehensive work-up to rule out other organisms are necessary and direct laryngoscopic examination remains the gold standard in diagnosing adults with suspected epiglotitis.
CONCLUSIONS: An astute medical diagnosis and proper treatment can potentially help avoid severe outcomes in patient with acute epiglottis.
Reference #1: Agrawal, A. Murphy, T. Haemophilus influenza infections in the H. influenza type b conjugate vaccine era. Journal of Clinical Microbiology. Nov 2011;49(11):3729-3732..
DISCLOSURE: The following authors have nothing to disclose: Lina Elbadawi, Rudy Tedja, Pramod Guru, Craig Daniels
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