Isolated Necrotizing Epiglottitis: Report of a Case in a Neutropenic Patient and Review of the Literature

Case report: An unusual case of 'black' larynx

Ulcerative necrotic supraglottitis is a rare entity of laryngeal infection leading rapidly in laryngeal necrosis, systematic complications and potentially fatal outcomes. We present a case of a 50-year-old gentleman with ulcerative necrotising supraglottitis and no co-morbidities who presented in Ear Nose and Throat Service in the Accident and Emergency department due to dysphagia and weakness. He was treated with an emergency tracheostomy with neck exploration and washout and received appropriate supporting antibiotic regime. He improved and was eventually decannulated, able to breathe phonate and swallow appropriately. After a thorough review of the literature regarding necrotising infections of the laryngeal cavity, only 7 cases have been reported, all in immunocompromised patients with severe complications. Our case report is the first ulcerative necrotic supraglottitis in a healthy individual who was treated early and aggressively with impressive results.

Necrotizing epiglottitis with necrotizing fasciitis in a child: A case report and review of literature

Necrotizing epiglottitis (NE) is a rare but extremely serious variant of acute bacterial epiglottitis. So far, it has been reported mostly in immunocompromised adults and only seldomly in the pediatric population. We describe the case of a 15-month-old immunocompetent child who presented to our tertiary referral center with necrotizing epiglottitis. This manuscript emphasizes the need for rapid recognition and surgical management of this unusual condition, as well as the importance of laryngeal preservation when facing overwhelming necrosis around the laryngeal cartilaginous framework. A review of the literature using MEDLINE, Embase and Web of Science databases was performed to discuss the epidemiology, bacteriology, treatment and prognosis of NE.

Necrotizing epiglottitis treated with early surgical debridement: A case report

OBJECTIVE

Necrotizing supraglottitis is a rare but potentially morbid infection most often seen in immunocompromised patients. All reported cases have utilized intravenous antibiotic therapy as the mainstay of treatment and many have had associated morbidities.

METHODS

We describe a case of a 50-year-old previously healthy female who presented with necrotizing epiglottis and was treated with immediate surgical debridement followed by directed antibiotic therapy.

RESULTS

Our patient rapidly recovered with no further invasive interventions. On follow up she had no further complications or functional deficits.

CONCLUSIONS

Although uncommon, providers should be aware of the potential benefits of early debridement when treating patients with similar pathology. Early surgical intervention should be considered to avoid local tissue loss, airway interventions, and long-term sequelae.

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

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 of Necrotizing Epiglottitis Due to Nontoxigenic Corynebacterium diphtheriae

Diphtheria is a rare cause of infection in highly vaccinated populations and may not be recognized by modern clinicians. Infections by nontoxigenic Corynebacterium diphtheriae are emerging. We report the first case of necrotizing epiglottitis secondary to nontoxigenic C diphtheriae. A fully vaccinated child developed fever, poor oral intake, and sore throat and was found to have necrotizing epiglottitis. Necrotizing epiglottitis predominantly occurs in the immunocompromised host. Laboratory evaluation revealed pancytopenia, and bone marrow biopsy was diagnostic for acute lymphoblastic leukemia. Clinicians should be aware of aggressive infections that identify immunocompromised patients. This case highlights the features of a reemerging pathogen, C diphtheriae.

Stenotrophomonas maltophilia: emerging disease patterns and challenges for treatment

Stenotrophomonas maltophilia is a ubiquitous organism associated with opportunistic infections. In the immunocompromised host, increasing prevalence and severity of illness is observed, particularly opportunistic bloodstream infections and pneumonia syndromes. In this article, the classification and microbiology are outlined, together with clinical presentation, outcomes and management of infections due to S. maltophilia. Although virulence mechanisms and the genetic basis of antibiotic resistance have been identified, a role for standardized and uniform reporting of antibiotic sensitivity is not defined. Infections due to S. maltophilia have traditionally been treated with trimethoprim-sulfamethoxazole, ticarcillin-clavulanic acid, or fluoroquinolone agents. The use of combination therapies, newer fluoroquinolone agents and tetracycline derivatives is discussed. Finally, measures to prevent transmission of S. maltophilia within healthcare facilities are reported, especially in at-risk patient populations.

A rare case of necrotising epiglottitis

We report a case of an acute necrotizing supraglottitis in a healthy patient. Only seven cases of necrotizing epiglottitis/supraglottitis have been reported in medical literature; all in immunocompromised patients. The features and characteristics of necrotizing epiglottitis are discussed with review of all previously reported cases.

Necrotizing epiglottitis in an infant: an unusual first presentation of human immunodeficiency virus infection

We describe the case of a 4-month-old infant presenting with severe respiratory distress secondary to necrotizing epiglottitis, who was subsequently diagnosed with human immunodeficiency virus infection. Additionally, we review the existing literature on this rare condition with a focus on the potential underlying pathogenesis.

Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis

With the introduction of vaccination for haemophilus influenza, the epidemiology of epiglottitis in children has changed. Classic childhood epiglottitis is now rare, and unusual forms of the disease may be seen. Nectrotizing epiglottitis is an extremely rare form of epiglottitis. Only four cases of nectrotizing epiglottitis have been previously reported, and all cases were in immunocompromised adult patients. Hemophagocytic lymphohistiocytosis is a rare condition characterized by high fevers, hepatosplenomegaly, and cytopenias caused by an abnormal proliferation and activation of macrophages. We report the first case of a previously healthy 5-year-old male presenting with acute onset of airway distress and pancytopenia. Subsequent airway evaluation led to the diagnosis of nectrotizing epiglottitis, and he was simultaneously diagnosed with infection-induced hemophagocytic lymphohistiocytosis. The patient recovered with intubation and antibiotics. Follow-up direct laryngoscopy revealed an epiglottis remnant with approximately 50% loss of epiglottic tissue. The presentation and pathophysiology of this unusual manifestation of epiglottitis and hemophagocytic lymphohistiocytosis will be reviewed. In the post-haemophilus influenze vaccination era, the pediatric otolaryngologist must be familiar with unusual forms of epiglottitis and its associated manifestations.

Infectious diseases of the head and neck: a review

A variety of infectious diseases may involve head and neck structures. These include bacterial, viral, fungal, and protozoal infections. This article describes the pathologic features of a variety of infectious diseases that surgical pathologists may encounter in analysis of tissue specimens from the head and neck area.