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Acute Epiglottitis Due to Haemophilus influenzae in an Adult: A Rare Cause of Refractory Septic Shock
October 2013, Vol 144, No. 4_MeetingAbstracts Critical Care | October 2013
Acute Epiglottitis Due to Haemophilus influenzae in an Adult: A Rare Cause of Refractory Septic Shock Subhas Sitaula, MD; Jhapat Thapa, MBBS; Ghanshyam Shastri, MD; Anil Ghimire, MD SUNY Upstate Medical University, Syracuse, NY Chest. 2013;144(4_MeetingAbstracts):332A. doi:10.1378/chest.1704983
Abstract SESSION TITLE: Critical Care Student/Resident Case Report Posters II SESSION TYPE: Medical Student/Resident Case Report PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM INTRODUCTION: Acute epiglottitis is an inflammation of the epiglottis and adjacent supraglottic structures [1]. It is an uncommon disease in adults with an estimated prevalence of 1 in 100,000 individuals. Although Hemophilus influnzae is the most common etiology of epiglottitis in children, it accounts for 3-14 percent of cases of epiglottitis in adults [2]. We present a case of acute epiglottitis in an adult presenting as acute respiratory failure and septic shock. CASE PRESENTATION: A 62 year old male with 2-3 day history of progressive sore throat, dysphagia and shortness of breath presented to the Emergency Room. On arrival, he was in respiratory distress and emergently taken to operating room for airway management in an anticipation of tracheotomy. He was successfully intubated by a team of ENT and anesthesiology. He was found to have profound edema of suproglottic structures on initial evaluation. He subsequently developed hypotension and signs of shock. He was treated with intravenous antibiotics (vancomycin and meropenem), steroids and transferred to medical ICU. On initial lab investigations, he was found to have metabolic acidosis, pancytopenia and acute renal failure. He required multiple vasopressor agents to keep his blood pressure. Furthermore, he required continuous veno-venous hemofiltration for acute renal failure and refractory acidosis. Despite medical therapy, the patient developed disseminated intravascular coagulation and died after 72 hours of hospital admission. Neck imaging didn’t show evidence of retropharyngeal abscess or necrotizing fasciitis. Initial blood culture grew H. influenza. A multi-disciplinary team approach was involved to manage the patient including Infectious disease, Hematology/ Oncology, Nephrology, ENT and Anesthesia. His past medical history was significant for hypertension and hypertensive chronic kidney disease stage III. He had no history of immunosuppressant, asplenia and was negative for HIV. DISCUSSION: Although Hemophilus influenza has been uncommon post vaccination era, it is still a major cause of epiglottitis in adults. It may cause serious complications and systemic infections in asplenic patients. We reported a case of severe sepsis and multi- organ failure due
to H influenza in a normo-splenic patient with no history of immunosuppression. Prompt recognition, early airway management and treatment of sepsis are the cornerstone of management. CONCLUSIONS: Our case highlights H influenza may present in a severe form of infection even in an adult. Careful evaluation and multi-disciplinary approach; judicial airway management and antibiotics selection is the key of treatment. Reference #1: Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am. 2006;53(2):215. Reference #2: Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH, Schiffman FJ. Acute epiglottitis. An 18-year experience in Rhode Island. Chest. 1995;108(6):1640. DISCLOSURE: The following authors have nothing to disclose: Subhas Sitaula, Jhapat Thapa, Ghanshyam Shastri, Anil Ghimire No Product/Research Disclosure Information
Acute Epiglottitis Due to Haemophilus influenzae in an Adult: A Rare Cause of Refractory Septic Shock Subhas Sitaula, MD; Jhapat Thapa, MBBS; Ghanshyam Shastri, MD; Anil Ghimire, MD SUNY Upstate Medical University, Syracuse, NY Chest. 2013;144(4_MeetingAbstracts):332A. doi:10.1378/chest.1704983
Abstract SESSION TITLE: Critical Care Student/Resident Case Report Posters II SESSION TYPE: Medical Student/Resident Case Report PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM INTRODUCTION: Acute epiglottitis is an inflammation of the epiglottis and adjacent supraglottic structures [1]. It is an uncommon disease in adults with an estimated prevalence of 1 in 100,000 individuals. Although Hemophilus influnzae is the most common etiology of epiglottitis in children, it accounts for 3-14 percent of cases of epiglottitis in adults [2]. We present a case of acute epiglottitis in an adult presenting as acute respiratory failure and septic shock. CASE PRESENTATION: A 62 year old male with 2-3 day history of progressive sore throat, dysphagia and shortness of breath presented to the Emergency Room. On arrival, he was in respiratory distress and emergently taken to operating room for airway management in an anticipation of tracheotomy. He was successfully intubated by a team of ENT and anesthesiology. He was found to have profound edema of suproglottic structures on initial evaluation. He subsequently developed hypotension and signs of shock. He was treated with intravenous antibiotics (vancomycin and meropenem), steroids and transferred to medical ICU. On initial lab investigations, he was found to have metabolic acidosis, pancytopenia and acute renal failure. He required multiple vasopressor agents to keep his blood pressure. Furthermore, he required continuous veno-venous hemofiltration for acute renal failure and refractory acidosis. Despite medical therapy, the patient developed disseminated intravascular coagulation and died after 72 hours of hospital admission. Neck imaging didn’t show evidence of retropharyngeal abscess or necrotizing fasciitis. Initial blood culture grew H. influenza. A multi-disciplinary team approach was involved to manage the patient including Infectious disease, Hematology/ Oncology, Nephrology, ENT and Anesthesia. His past medical history was significant for hypertension and hypertensive chronic kidney disease stage III. He had no history of immunosuppressant, asplenia and was negative for HIV. DISCUSSION: Although Hemophilus influenza has been uncommon post vaccination era, it is still a major cause of epiglottitis in adults. It may cause serious complications and systemic infections in asplenic patients. We reported a case of severe sepsis and multi- organ failure due
to H influenza in a normo-splenic patient with no history of immunosuppression. Prompt recognition, early airway management and treatment of sepsis are the cornerstone of management. CONCLUSIONS: Our case highlights H influenza may present in a severe form of infection even in an adult. Careful evaluation and multi-disciplinary approach; judicial airway management and antibiotics selection is the key of treatment. Reference #1: Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am. 2006;53(2):215. Reference #2: Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH, Schiffman FJ. Acute epiglottitis. An 18-year experience in Rhode Island. Chest. 1995;108(6):1640. DISCLOSURE: The following authors have nothing to disclose: Subhas Sitaula, Jhapat Thapa, Ghanshyam Shastri, Anil Ghimire No Product/Research Disclosure Information