Acute Epiglottitis in the Immunocompromised Host: Case Report and Review of the Literature

Abstract

We present a case of acute epiglottitis in a 16-year-old with severe aplastic anemia. He was admitted with a history suggestive of a severe upper airway infection and an absolute neutrophil count of 0 per cubic millimeter. Despite his immunocompromised state, he presented with the classical signs and symptoms of epiglottitis. We review here the presentation and comorbidities of immunocompromised patients with epiglottitis. In addition, the appropriate choice of empirical antibiotic therapy is important for the management of epiglottitis in immunocompromised patients, especially in the post–Haemophilus influenza type B vaccination era. In our patient, Enterobacter cloacae was isolated from endoscopically directed throat cultures, and treatment was successful without the need for intubation. The current literature suggests that in immunocompromised patients, particularly those who are neutropenic, there is a potentially wide range of organisms, both bacterial and fungal, that may play a role in the pathology of acute epiglottitis.

A case report of serotype W135 Neisseria meningitidis epiglottitis in the United States and review of twelve adult cases of meningococcal epiglottitis

“…It is known that immunocompromised patients are more susceptible to infections and there should be a low threshold of suspicion for diagnosis of epiglottitis in those presenting with symptoms and neutropenia [ 20 ]. Chen et al reviewed 48 cases of epiglottitis in immunocompromised hosts (age range 4 months to 70 years, with mean age of 35.5 years), in which 50% were immunocompromised secondary to cancer and/or chemotherapy, 25% had human immunodeficiency virus (HIV), and nearly 38% were neutropenic (defined as absolute neutrophil count and/or white blood cell count <1000 per cubic millimeter) [ 20 ]. None of the cases resulted from long-term corticosteroid use.…”

“…Neisseria spp. were isolated in two patients (one neutropenic and one non-neutropenic) out of the 48 reviewed [ 20 ]. Our case patient was on long-term steroid therapy for RA, but he did not have diabetes mellitus.…”

Epiglottitis and Complicated Epiglottitis – A Narrative Review

“…Immunocompromised patients are susceptible to Pseudomonas aeruginosa and Candida. Noninfectious causes are mainly traumatic such as corrosive, thermal or foreign body ingestion [9][10][11].…”

Pediatric Ear, Nose, and Throat Field Infectious Disease Emergencies

“…are the main microorganisms that can cause epiglottitis. Candida albicans may be the cause of epiglottitis in immunosuppressed patients [32]. Sudden onset of fever, stridor, drooling, and hot potato sound are seen, and cough is not a common finding.…”