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Tatouli I, Dedes N, Bozikas A, Melliou S, Pavlou MM, Kontogiannis S, Kyrodimos E, Kanioura E, Ntanasis-Stathopoulos I, Dimopoulos MA, Dimopoulos G, Kastritis E, Gavriatopoulou M. Necrotizing Laryngitis in Patients with Hematologic Disease: The First Case-Report Due to PDR Acinetobacter baumannii and Literature Review. Microorganisms 2024; 12:1382. [PMID: 39065149 PMCID: PMC11279041 DOI: 10.3390/microorganisms12071382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Immunocompromised patients with hematologic diseases may experience life-threatening infections with rather uncommon manifestations. Laryngitis has been described as a potential infection in such vulnerable patients and may result in major complications, ranging from impending airway obstruction to total laryngeal necrosis. Immediate laryngoscopy is of paramount importance, as it provides quantification of laryngeal edema and evidence of necrosis. Documentation of the causative pathogen is usually feasible through tissue culture. In the literature, 14 cases of necrotizing laryngitis have already been published. Here, we present the case of a 38-year-old male with a recent diagnosis of multiple myeloma, who received the first cycle of therapy a few days before admission. The patient presented with neutropenic fever, diarrhea, and multiple organ dysfunction. His course was complicated with hemophagocytic lymphohistiocytosis and stridor. A diagnosis of necrotizing laryngitis attributed to Acinetobacter baumannii invasion of the larynx was established. This manuscript highlights that the management of patients with hematologic disease and necrotizing laryngitis should be coordinated in highly specialized centers and clinicians should have a high level of clinical suspicion and act promptly.
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Affiliation(s)
- Ioanna Tatouli
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Nikolaos Dedes
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Andreas Bozikas
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Stamatoula Melliou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Maria-Markella Pavlou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Sofoklis Kontogiannis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Efthymios Kyrodimos
- First Department of Otolaryngology, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.)
| | - Eftychia Kanioura
- First Department of Otolaryngology, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.)
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - George Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
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Chen C, Natarajan M, Bianchi D, Aue G, Powers JH. Acute Epiglottitis in the Immunocompromised Host: Case Report and Review of the Literature. Open Forum Infect Dis 2018; 5:ofy038. [PMID: 29564363 PMCID: PMC5846294 DOI: 10.1093/ofid/ofy038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/14/2018] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
- Cheng Chen
- University of Cambridge, Cambridge, United Kingdom
| | - Mukil Natarajan
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David Bianchi
- National Institute on Deafness and Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Georg Aue
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - John H Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryl
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Abstract
We report an 8-year-old boy who developed a life-threatening acute epiglottitis during induction chemotherapy for acute promyelocytic leukemia. He survived the infection with emergency tracheostomy, treatment with broad spectrum antibiotics and amphotericin, and the use of granulocyte-macrophage colony stimulating factor. No organism was identified. A literature review identified 18 cases of acute epiglottitis in cancer patients. Sixteen of them were suffering from hematologic malignancies and three patients had received bone marrow transplantation. Unlike the usual case of epiglottitis, the majority (15 out of 18) of affected patients were adults and none of the infections was associated with Haemophilus influenzae. Streptococcus pneumoniae and Candida albicans were the most frequently identified pathogens. Early recognition and aggressive supportive care are required for successful management.
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Affiliation(s)
- Anselm C W Lee
- Department of Paediatrics, Tuen Mun Hospital, New Territories, Hong Kong, China.
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Kraus M, Gatot A, Leiberman A, Nash M, Fliss DM. Acute necrotizing epiglottitis resulting in necrotizing fasciitis of the neck and chest. Otolaryngol Head Neck Surg 2001; 124:700-1. [PMID: 11391269 DOI: 10.1177/019459980112400624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Kraus
- Department of Otolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
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Connolly AA, Rowe-Jones J, Leighton SE, Ball SE, Davies EG, Moore-Gillon V. Pseudomonal supraglottitis occurring in a patient with profound neutropenia secondary to virus-associated haemophagocytic syndrome. J Laryngol Otol 1992; 106:739-40. [PMID: 1328436 DOI: 10.1017/s0022215100120742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We present a case of virus-associated haemophagocytic syndrome following Epstein-Barr virus infection in which a fulminant pseudomonal supraglottitis developed. Increasingly, unusual pathogens have been found in immunocompromised patients. This is the first reported case of pseudomonal supraglottitis.
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Affiliation(s)
- A A Connolly
- Department of Otolaryngology and Head and Neck Surgery, Royal Infirmary, Glasgow
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