Bacterial epiglottitis superimposed on oropharyngeal cancer: A case report

Abstract

Background: Patients undergoing chemotherapy and radiotherapy are placed in an immunocompromised state worth consideration in the event of potential airway compromise, especially when superimposed on an airway-obstructing tumor. We report a case of bacterial epiglottitis in a patient with active oropharyngeal cancer (OPC), who presented in such a way that an infectious etiology was not initially considered in the patient's care. To our knowledge, such a circumstance has not been reported in the literature.

Case: Here, we report a case of a 68-year-old male with advanced-stage OPC who developed respiratory distress and underwent emergent tracheostomy. The patient was diagnosed postoperatively with Haemophilus influenza and Pseudomonas aerugeniosa. Following antibiotic treatment, the patient recovered to the point in which he could then undergo concomitant chemoradiation. The patient later had a recurrence of P. aerugeniosa during their radiotherapy that was also treated with antibiotics. The patient experienced continued symptoms related to their OPC and underwent pharyngectomy. Despite the initial success of this procedure, the patient experienced tumor recurrence and succumbed to his disease.

Conclusion: This case underscores the importance of considering multiple etiologies concerning airway compromise, as the consequence of delayed cancer treatment may be loss of local cancer control.

Keywords: airway-obstructing tumor; emergent tracheostomy; epiglottitis; oropharyngeal cancer; recurrent airway infection.

FIGURE 1

A—Sagittal CT view of the tumor and normal epiglottis on initial presentation to the Emergency Department, with arrow pointing to patient's tumor. B—Sagittal view of the tumor and enlarged epiglottis now contacting the tumor and causing airway obstruction, 14 days after admission (arrow points to tumor contacting epiglottis). C—Sagittal view showing an excellent tumor response and resolution of epiglottis by the last day of radiotherapy (arrow points to normal‐sized epiglottis, no longer in contact with tumor)

FIGURE 2

The patient's dose distribution mapping in three views, showing both an oropharyngeal tumor and epiglottitis. Note the inflamed epiglottitis contacting the tumor

FIGURE 3

Head and neck CT axial (left) and coronal (right) views showing the patient's recurrent oropharyngeal mass, with blue arrows pointing directly to the mass. Measurements to the right of each view show the approximate cross‐sectional area of the mass. This lesion was considered to be resectable based on imaging.

FIGURE 4

Histopathological examination of the patient's malignant neoplasm, with demonstrated perineural invasion with atypical keratinized squamous cells (blue arrow) and foreign body giant cell reaction (red arrow). Samples were obtained during partial pharyngectomy with left modified neck dissection for recurrent squamous cell carcinoma (10X magnification).