Case Presentation:
A 70‐year‐old man presented with sore throat, cough, and increasing respiratory distress. He was tachycardic and tachypneic, with a fever of 101.5°F. His breathing was labored and stridorous. He had no angio‐edema. His oropharynx was erythematous without exudate. His anterior neck was tender. Breath sounds were decreased in all lungs fields, with no wheezing or crackles. The patient was intubated and placed on mechanical ventilation in the intensive care unit. Intubation was difficult because of edema of the oropharynx and epiglottitis. Blood cultures were drawn. Empiric antibiotic therapy with cef‐triaxone and clindamycin was begun. A neck CT revealed extensive edema of the pharyngeal soft tissues from the nasopharynx to the true vocal cords including the epiglottis. Blood cultures were positive for beta‐lactamase negative Haemophilus influenzae 1 day after admission. He was treated for acute Haemophilus influenzae epiglottis with cef‐triaxone and dexamethasone. Three days after admission, a repeat neck CT displayed moderate improvement of the pharyngeal edema. The patient was extubated on his fifth day of hospitalization without complication. His clinical condition quickly improved, and he was discharged with oral amoxicillin‐clavulanate antibiotic therapy. The blood sample received by the Louisiana central laboratory was positive for Haemophilus influenza type B.
Discussion:
The incidence of childhood epiglottitis has decreased, yet the incidence of epiglottitis in adults is about 2.5 times greater. This is the first reported case of Haemophilus influenzae type B epiglottitis in Louisiana since 2005. A variety of pathogens are implicated in the development of adult epi‐glottitis, including Haemophilus influenzae, Staphylococcus aureus, streptococci species, and anaerobes. The average age for diagnosis is between 42 and 48 years old. Adults most often experience sore throat, whereas odynophagia, dysphagia, cough, dyspnea, drooling, hoarseness, and stri‐dor are observed more frequently in children. Other physical findings include fever, tachypnea, lymphadenopathy, and tenderness of the anterior neck. The differential diagnosis for upper airway obstruction includes epiglottis, pharyngitis, infectious mononucleosis, tonsillitis, peritonsillar abscess, Ludwig angina, laryngitis, angioedema, gastro‐esophageal reflux disease, tumor, trauma, and inhalation or ingestion injury.
Conclusions:
Medical therapy begins with broad‐spectrum antibiotics to cover gram‐positive organisms, Haemophilus influenzae type B, and anaerobes. Although controversial, corticosteroids are often given to reduce swelling. Stridor, muffled voice, rapid clinical course, diabetes mellitus, visualization of less than half of the posterior vocal folds, and extension of swelling to the arytenoids are factors that have been associated with the need for airway intervention. Epiglottitis should not be overlooked in the differential diagnosis of an adult who presents with symptoms of upper airway obstruction.
Disclosures:
J. Moscona ‐ none