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A case of acute Epiglottitis in an Adult Leukemia Patient

Epiglottitis is defined as an acute infection of the supraglottic larynx which may require an emergency airway management.
In Emergency room you can diagnose a patient by symptoms of airway obstruction. Fibreoptic laryngosocpy (see the case report) or soft tissue lateral x-ray neck (see picture below) are the other preferred methods of diagnosis. Indirect laryngoscopy should be done with caution since patient gagging may worsen or participate catastrophic airway obstruction.
This case report describes a neutropenic patient with epiglottitis who was subsequently diagnosed as having acute promyelocytic leukemia.
Case Report: A 50 year old woman presented with a week long history of pain on swallowing and dysphagia. The odynophagia was gradually progressive and more for solids than liquids.
4 months back, she had been diagnosed as having tuberculous lymphadenitis and started on anti koch's treatment (AKT). The AKT had to be stopped three days before she came to us because of persistent neutropenia.
On examination, she was otherwise normal with no temperature or dyspnea. On palpation, she did have a slight tenderness of the laryngeal frame work. We were unable to find a definitive cause of pain in the throat and performed an indirect laryngoscopic examination which revealed a ‘cherry-red’ epiglottitis with slough at the base of the epiglottis. Fibreoptic laryngoscopy confirmed the diagnosis of epiglottitis (As seen in the picture ).
She was admitted for observation and emergency airway management if such a situation arose. A throat swab was sent and routine haemogram(CBC) started her on Ceftriaxone. The doctor did not give her steroids as she was a diabetic and was also immunosupressed.
Her haemogram was repeated daily and it showed a persistent low white blood cell count (WBC) and platelet count. The throat swab revealed Beta hemolytic Streptococcus pyogenes sensitive to Cephalosporins. When her CBC did not improve even after three days of administering granulocyte-macrophage colony stimulating factor, A bone marrow biopsy was done. This revealed that she was suffering from acute promyelocytic leukemia with thrombocytopenia .

She was started on induction chemotherapy, supported by multiple blood and blood factor transfusions.  The disease went into remission on the 18th day