ABSTRACT
Supraglottitis is an ear, nose and throat emergency where swelling of the laryngeal structures can threaten to fatally obstruct the airway. Most cases of supraglottitis are of infective origin but other rarer causes have been documented. We present two patients who presented with stridor and were found to have supraglottic oedema on fibreoptic nasolaryngoscopy. Both patients presented with odynophagia and progressive dyspnoea and were initially medically managed to stabilise their airway. This included intravenous steroids, nebulised epinephrine and intravenous antibiotics. After this initial treatment they both required investigation and optimisation of their underlying medical conditions (rheumatoid arthritis with possible systemic lupus erythematosus and nephrotic syndrome) as more definitive management.
Subject(s)
Arthritis, Rheumatoid/complications , Nephrotic Syndrome/complications , Supraglottitis/diagnosis , Supraglottitis/etiology , Deglutition Disorders/etiology , Dyspnea/diagnosis , Dyspnea/etiology , Female , Humans , Laryngoscopy , Middle Aged , Steroids/administration & dosage , Supraglottitis/drug therapyABSTRACT
Chronic non-granulomatous supraglottitis (CNGS) is a rare disorder of the supraglottic larynx, characterised by chronic supraglottic inflammation in the absence of granulomata, vasculitis, neoplasia, autoimmune disease or infective changes on histology. We present the case of a male adolescentwho attended with progressively worsening exertional dyspnoea, stridor and symptoms of obstructive sleep apnoea. Flexible nasendoscopy revealed marked supraglottic subepithelial thickening sparing the glottis and subglottis, confirmed on microlaryngoscopy. MRI of the head and neck demonstrated diffuse, homogenous supraglottic oedema. At the peak of his symptomology, the patient was admitted for further investigations and intravenous steroid therapy, and switched to prolonged oral steroids on discharge. Tracheostomy was avoided. After 3 months, he was successfully weaned from steroids to azathioprine with gradual symptomatic improvement. This case represents the first successful use of a steroid-sparing agent in the management of CNGS.
Subject(s)
Azathioprine/therapeutic use , Immunosuppressive Agents/therapeutic use , Supraglottitis/drug therapy , Adolescent , Chronic Disease , Epiglottis/pathology , Humans , Male , Supraglottitis/pathology , Treatment OutcomeABSTRACT
Acute supraglottitis is a medical emergency as it can rapidly lead to airway compromise. With routine pediatric immunization for Hemophilus influenzae serotype b, supraglottitis is now more prevalent in adults, with a shift in the causative organisms and a change in the natural history of this disease. Here, we present a case of supraglottitis due to group B streptococcus that occurred in an adult with previously undetected immunoglobulin 4 (IgG4) and complement protein C2 deficiency.
Subject(s)
Immunocompromised Host/immunology , Streptococcal Infections/diagnosis , Streptococcus agalactiae/isolation & purification , Supraglottitis/immunology , Supraglottitis/microbiology , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Complement C2/deficiency , Complement C2/immunology , Emergency Service, Hospital , Follow-Up Studies , Humans , IgG Deficiency/immunology , Male , Rare Diseases , Risk Assessment , Severity of Illness Index , Streptococcal Infections/drug therapy , Supraglottitis/diagnosis , Supraglottitis/drug therapy , Treatment OutcomeABSTRACT
A 50-year-old gentleman presented to the emergency department with a 24 h history of stridor, dysphonia, dysphagia and vomiting. On examination, the patient had fever and tachycardic. There was no palpable cervical lymphadenopathy. Flexible nasendoscopy and lateral neck x-ray revealed soft tissue swelling around the epiglottis. The swelling subsided with conservative management of intravenous antibiotics and steroids, only to later reveal a vallecular cyst, which was confirmed on microlaryngoscopy. The cyst was subsequently deroofed and sent for biopsy. Histological examination revealed an infected, benign vallecular cyst consisting of a squamous epithelium with underlying lymphoid tissue. In adults, vallecular cysts are usually asymptomatic, but can become infected and initiate acute supraglottitis, potentially leading to life-threatening airway obstruction. The case described here, although rare, highlights how early definitive diagnosis and management of vallecular cysts can lead to significantly improved patient outcomes.
Subject(s)
Cysts/diagnosis , Cysts/drug therapy , Laryngeal Diseases/diagnosis , Laryngeal Diseases/drug therapy , Supraglottitis/diagnosis , Supraglottitis/drug therapy , Anti-Bacterial Agents/therapeutic use , Biopsy , Diagnosis, Differential , Drug Therapy, Combination , Humans , Laryngoscopy , Male , Middle Aged , Steroids/therapeutic useABSTRACT
OBJECTIVE: We report the first UK case of supraglottitis secondary to Neisseria meningitidis. METHOD: Case report with review of the current literature on supraglottitis and its aetiology. RESULTS: An 89-year-old woman was referred with worsening symptoms of dysphagia, hoarseness and neck discomfort. After nasopharyngoscopy and neck X-ray, supraglottitis was diagnosed. Prompt treatment comprised nebulised adrenaline, oxygen therapy and intravenous antibiotics. Microbiology samples grew N meningitidis, a notifiable disease in the UK. Public health officials were informed, and full precautions and prophylactic treatment initiated for those at risk. The patient made excellent progress and was discharged several days later. DISCUSSION AND CONCLUSION: Supraglottitis occurs in <4 per 100 000 population. Following a successful UK childhood immunisation programme, most cases occur in adults. Supraglottitis secondary to N meningitidis is exceptionally rare, with only seven other reported cases worldwide. Morbidity is exceptionally high; over 60 per cent of patients require airway intervention. To our knowledge, this is the first reported UK case of supraglottitis secondary to N meningitidis. This case highlights the important clinical, diagnostic and therapeutic interventions required to prevent complications associated with this potentially fatal condition.
