Acute Emphysematous Epiglottitis: A Case Report

Abstract

Epiglottitis is a bacterial infection of the upper respiratory tract that can be rapidly progressive and life‐threatening. Though predominantly seen in unvaccinated children, there seems to be a shift with the incidence of adult cases rising following the Haemophilus Influenza B (HiB) vaccine. There are several reports of epiglottitis manifesting as an abscess, but few cases report on the formation of an emphysematous abscess. Additionally, little is known on the bacterial etiology of such infections. Here, we present a case of a patient found to have acute emphysematous epiglottis managed with fiberoptic intubation, drainage, and culture of the abscess. Laryngoscope, 133:2747–2750, 2023

Mucosal emphysematous head and neck infections: Scoping review and a case of emphysematous tonsillitis

“…The severity of presentations and onset of symptoms varied across cases. Airway compromise was a concern in four cases, 2 , 3 , 16 , 17 and notably these patients did not necessarily initially present with respiratory distress. One case was rapidly progressive, where the patient's odynophagia and dysphagia progressed to dysphonia and inability to swallow secretions within one day.…”

“…Only one patient had cultures of their emphysematous abscess, of which the anaerobic culture speciated to Prevotella melaninogenica and Fusobacterium necrophorum . 3 In the case of infectious mononucleosis hemorrhagic tonsillitis, blood cultures confirmed EBV infection. 15 However, it was not disclosed whether any further cultures were directly taken from the tonsils to rule out a superimposed infection.…”

“…In the cases that were rapidly progressive or where there was immediate concern for airway compromise, patients underwent awake fiber‐optic intubation to secure the airway. 2 , 3 There was a case with noticeable airway narrowing where there was concern for impending airway compromise based on CT findings, but the patient recovered on antibiotics before intubation was required. 17 In all cases where treatment was disclosed, medical management included broad spectrum antibiotics.…”

“…Patients who began on IV antibiotics were eventually transitioned to oral antibiotics. In the two more severe and progressive cases where intubation was required to protect the airway, 2 , 3 patients also underwent surgical management, which consisted of incision and drainage of the emphysematous abscess. In case reports where the focus was on initial presentation or radiologic findings, there was limited information provided on management.…”

“…Emphysematous infections of the upper aerodigestive tract are extremely uncommon, with only a handful of reported cases of emphysematous epiglottitis and supraglottitis 1 , 2 , 3 in the literature. An emphysematous infection of the tonsils has not been reported previously.…”