(Figure
2C- Imagine captured through video-laryngoscope on follow-up)
Discussion :
Acute Epiglottitis in Adults: The presented case highlights an
uncommon complication of acute epiglottitis, traditionally associated
with pediatric populations [19]. The post-conjugate vaccine era has
seen a shift in its epidemiology, with adults now occasionally
presenting with this once predominantly pediatric condition [12,13].
While the incidence in adults has increased, the complications,
particularly acute upper airway obstruction, remain exceedingly rare.
This case challenges the prevailing understanding, emphasizing the
importance of vigilance in recognizing atypical presentations
[20,21].
Clinical Presentation and Diagnosis: The patient’s initial
symptoms of sore throat, vomiting, and fever are consistent with the
prodromal phase of acute epiglottitis [14]. However, the unique
aspect of this case lies in the rapid progression to acute upper airway
obstruction in an adult patient. Clinical examination revealed bilateral
tonsillar hypertrophy and stridor [20,21], indicative of the
severity of the condition. The decision for emergency tracheostomy was
imperative to ensure a patent airway and avert a life-threatening
crisis.
Surgical Intervention and Intraoperative Findings : The
emergency tracheostomy, performed under local anesthesia, played a
crucial role in securing the airway promptly. Intraoperatively,
significant swelling of the epiglottis was observed [3,22]. Notably,
bilateral arytenoids, and aryepiglottic folds the true and false vocal
cords appeared normal, highlighting the localized nature of the
inflammatory process. The absence of visible pyriformis due to swelling
further contributed to the understanding of the extent of tissue
inflammation.
Laboratory and Radiological Findings: Laboratory
investigations, indicated an elevated platelet count and inflammatory
markers, reflecting the acute nature of the condition. Radiological
assessments, such as imaging of the neck or direct visualization through
fiberoptic laryngoscopy [2,23], provided additional insights into
the extent of inflammation and supported the diagnosis as explicitly
mentioned in the case.
Treatment and Outcome: The patient responded well to the
instituted treatment regimen, including antibiotic therapy and
anti-inflammatory medications [24,25]. Absence of breathing
difficulties at discharge signify the effectiveness of the
interventions. The postoperative course was uneventful, highlighting the
importance of early recognition, prompt intervention, and appropriate
postoperative care.
Conclusion and Implications :
This case contributes to the limited literature on acute epiglottitis in
adults, emphasizing the need for heightened awareness among healthcare
providers. The rarity of complications in adults necessitates a thorough
understanding of atypical presentations to ensure timely and effective
management. Furthermore, the case highlights the importance of
considering acute epiglottitis in the differential diagnosis of
respiratory distress in adults, especially in the absence of typical
pediatric risk factors. Continued surveillance and reporting of such
cases will further refine our understanding of this evolving clinical
entity.