A Case of Adult Epiglottitis in a Patient With Uncontrolled Diabetes and Occupational Risks

Abstract

Epiglottitis is inflammation of the epiglottis with or without the involvement of supraglottic structures including the hypopharynx. Timely diagnosis is crucial as the treatment of epiglottitis is tailored to the degree of airway obstruction. Most patients improve with conservative measures, while some require an emergent airway intervention. We report a case of a 39-year-old Caucasian male with a history of uncontrolled diabetes mellitus and smoking who presented to the emergency department (ED) with a sore throat, dry cough, odynophagia, and difficulty swallowing. He was afebrile, tachycardic, tachypneic, hypertensive, and saturating at 99% on room air. His physical examination was remarkable for drooling, muffled voice, pharyngeal swelling, and erythema. Laboratory tests were significant for leukocytosis, hyperglycemia, and hemoglobin A1c (HbA1c) of 14.3% with a negative infectious workup. Lateral neck X-ray and emergent direct fiberoptic laryngoscopy revealed findings of epiglottitis with airway patency. The patient did not require intubation and was started on intravenous dexamethasone, vancomycin, ampicillin-sulbactam, and humidified air with suctioning of secretions and quickly recovered. In addition to known risk factors for developing epiglottitis such as uncontrolled diabetes and smoking, our patient was exposed to metal shavings at his new job, an occupational hazard that might have contributed to his clinical presentation. Our case highlights the importance of a prompt diagnosis and risk factor identification in the management of epiglottitis in adults.

Keywords: acute epiglottitis in adults; airway compromise; infectious; inhalation injury; metal shavings; smoking cessation; staphylococcus; streptococcus; thickening of the epiglottis and aryepiglottic folds; uncontrolled diabetes mellitus.

Figure 1. Lateral neck X-ray

A: Thickening of the palatine tonsils. B: Thickening of the epiglottis. C: Thickening of the aryepiglottic folds. D: Patent airway.