Lesson of the Week: Adult epiglottitis: prompt diagnosis saves lives

Abstract

* Morality from adult epilottis may be reduced by prompt action, which requires increased awareness of the disease's existence Acute epiglottitis is a well recognised life threatening infectious disease of children. It is so uncommon in adults that many doctors are unaware of its existence, and few have experience of a case. Failure to diagnose epiglottitis early in adults undoubtedly contributes to its continuing mortality, which may be higher than in children.1 We report two cases of adult epiglottitis seen over three years in this emergency department. In one case diagnosis was prompt and the patient survived, and in the other epiglottitis was not diagnosed and the patient died. ### Case 1 In July 1990 a 35 year old white man referred himself to the emergency department on a weekday afternoon, having suffered for five days with a sore throat that had started two days after returning from holiday in Portugal. In the morning the pain had increased and he had difficulty in swallowing and had experienced rigors. The triage nurse observed that he had a painful throat and was shaking. He had a high fever (39.4°C) and was noted to be only mildly distressed. His pharynx was inflamed, with minimal tonsillar enlargement; he had bilateral upper cervical lymphadenopathy. A senior house officer diagnosed a bacterial upper respiratory tract infection. Despite the history of rigors no blood cultures or throat swabs were taken, and the patient was discharged with phenoxymethyl-penicillin 500mg to be taken four times daily, having been advised to see his …