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Case Reports
. 2025 Apr 17:1-10.
doi: 10.1159/000545927. Online ahead of print.

Epiglottitis in Patients Treated for Acute Leukemia: Case Series and Systematic Review of the Literature

Adi Sherban  1   2 , Avraham Frisch  3 , Alon Rozenthal  4   5 , Shira Buchrits  4   5 , Baha Atamna  4   5 , Daniel Ben-Ner  6 , Sivan Eden  7 , Ala Atamna  5   8 , Yishai Ofran  9 , Pia Raanani  4   5 , Ofir Wolach  4   5
Affiliations
Case Reports

Epiglottitis in Patients Treated for Acute Leukemia: Case Series and Systematic Review of the Literature

Adi Sherban et al. Acta Haematol. .

Abstract

Introduction: Acute epiglottitis is a medical emergency characterized by inflammation of supraglottic structures of the larynx and epiglottis. The clinical characteristics and course of this complication in acute leukemia (AL) are largely unknown. We present a case series and a systematic review of the literature of adult patients with AL and acute epiglottitis.

Case presentation: Four patients with acute myeloid leukemia (age 38-61 years) were diagnosed with acute epiglottitis during their intensive treatment course. One patient presented with epiglottitis at the end of induction, two at the end of consolidation therapy, and 1 patient presented with a later event. Three patients were in grade 4 neutropenia during infection onset (median aplasia duration to event 9 [range 4-14] days). All patients presented with neck pain and dysphagia and 2 patients also had dyspnea at presentation. Urgent invasive airway protection was required in 3 patients. Two patients died due to this complication, one suffered anoxic brain injury. A systematic literature review identified 8 additional cases of epiglottitis.

Conclusion: Acute epiglottis is a rare but significant medical emergency with unique challenges in the setting of AL that is caused by atypical infectious pathogens. Early detection and a multidisciplinary therapeutic effort are crucial to improve patient outcome.

Keywords: Acute leukemia; Epiglottitis; Infection complication.

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Conflict of interest statement

Prof. Pia Raanani was a member of the Journal’s Editorial Board at the time of submission. The remaining authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Patient #1. a Fibro-optic examination. The epiglottis is slightly edematous, the left arytenoid is completely obscured due to pressure from the left pharyngeal wall, and the left piriform sinus is not visible due to the edema and pressure (arrow). b CT scan. A midsagittal slice and an axial slice at the level of the epiglottis demonstrate significant edema in the pharyngeal cavity with thickening of the epiglottis and the aryepiglottic folds, leading to narrowing of the airway (arrows).
Fig. 2.
Fig. 2.
Patient #2. a Fibro-optic examination – first examination, normal throat examination. b Fibro-optic examination 3 h post-admission. Diffuse supraglottic edema, significant saliva stagnation in the hypopharynx (arrow). c CT scan. A midsagittal slice showing thickening of the epiglottis.
Fig. 3.
Fig. 3.
Flowchart of systematic literature review and study selection.
See this image and copyright information in PMC

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