View Abstract

A1789 - Acute Epiglottitis Due to Group B Streptococcus in an Adult
Author Block: V. Kaul1, F. K. Suhail2, M. E. Warshawsky3; 1Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine / Elmhurst Hospital Center, Elmhurst, NY, United States, 2St. George's University School of Medicine, Great River, NY, United States, 3Elmhurst Hosp Ctr, Elmhurst, NY, United States.
INTRODUCTION: Acute epiglottitis is a well-recognized life threatening infectious disease of children, in most cases. The incidence of epiglottitis in children has declined with the introduction of Hemophilus influenza (Hib) vaccination. However, acute epiglottitis is under-recognized in adults. We present a case of a young adult man with group B streptococcus (GBS) epiglottitis who was very difficult to intubate. CASE: Our patient is a 42-year-old man with a history of alcohol abuse and Type 2 diabetes who initially presented with nausea and vomiting and found to have diabetic ketoacidosis (DKA). He also complained of difficulty breathing and throat pain. Physical examination was notable for stridor. Otolaryngology was consulted and video laryngoscopy (vl) was performed with findings of diffusely pale edematous epiglottis and arytenoids and a “pinpoint airway”, making it a difficult intubation case. The patient was intubated for airway protection with vl guidance. The patient was started on IV steroids, ampicillin-sulbactam pending sputum cultures and DKA was treated with insulin and IV fluids. Sputum cultures grew Group B streptococcus. The respiratory viral panel was positive for human metapneumovirus as well. He was extubated without an event on day three of admission. Post extubation flexible fiberoptic laryngoscopy was notable for patent airway and patient was discharged from the ICU to complete a course of antibiotics and a taper of steroids. DISCUSSION: Since the introduction of the Hib vaccine, there has been a significant decline in the incidence of epiglottitis among children. However, recent studies have shown an increase in incidence of adult epiglottitis without any identifiable predominant causative pathogen. This could be in part due to increased recognition of epiglottitis in adults by treating providers. In most cases, blood and throat cultures are negative however some of the most common pathogens include Hib, other strains of H. influenzae, S.pneumoniae and viruses. A 2014 case report published in The Laryngoscope describing GBS epiglottitis that had occurred in an adult with previously undetected IgG and C2 deficiency, however it is a rarely reported pathogen. It is unclear what risk factors lead to GBS epiglottitis in our patient. Nevertheless vigilance is indicated due to the risk of a rapidly evolving airway obstruction and benefit of early treatment as seen in our case.