(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.