A 28-Year-Old Male with Fever and Difficulty Swallowing

Differential Diagnosis

• Epiglottitis
• Lemierre’s syndrome
• Peritonsillar abscess
• Viral pharyngitis

Diagnosis

This patient was diagnosed with epiglottitis, the most telling sign of which is the rounded “thumb-like” appearance of the epiglottis in the soft tissue neck lateral view above.

Learnings/What to Look for

• Consider the “four Ds” of acute epiglottitis : dysphagia, dysphonia, drooling, and distress
• Haemophilus influenzae type B has been the most common infective cause, historically, but group A beta-hemolytic Streptococci is becoming more common since the advent of HiB vaccinations; this is now largely a disease of adults
• Causes of epiglottitis may be inflammatory (sarcoidosis), infective (including atypical causes such as tuberculosis), or traumatic (a direct blow to the throat)

Pearls for Urgent Car Management and Considerations for Transfer

• Epiglottitis is a potentially life-threatening emergency
• Airway management is paramount; intubation or cricothyroidotomy may be needed

Consider administering dexamethasone while awaiting EMS transport to the ED