An infant with streptococcal uvulitis presenting with airway obstruction.

We report a case of 7-month-old infant girl with severe uvulitis with airway obstruction. Her uvula was erythematous and markedly swollen. Stridor and retraction were noted. The symptoms were resolved after treatment with ampicillin, and a throat swab isolated Group A streptococcus. It is extremely rare in children for uvulitis to cause respiratory distress from airway obstruction. However, in infants with narrow airways, physicians should consider the risk of progression to respiratory distress.

A 7-month-old infant girl was taken by her parent to the doctor with fussiness, having fed and slept poorly the previous evening. She demonstrated stridor and a markedly swollen uvula, raising concerns for emergency airway management. She was transferred to our hospital. She was lucid but irritable on admission. A physical examination revealed a respiratory rate 42 breaths/minute, pulse 137 beats/minute, blood pressure(systolic) 102 mmHg, body temperature of 37.1℃, and a room-air pulse oximetry reading of 98 %. Her uvula was erythematous with marked edematous swelling (Fig. 1). Palatine tonsil swelling was not found. Stridor and suprasternal retraction were also noted.

Fig. 1

Uvula was erythematous with marked edematous swelling.

Fiberscopic evaluation revealed mild pharyngeal erythema with a normal epiglottis and vocal cords. Other than the swollen uvula, no lesions capable of causing upper airway obstruction were found. Intravenous ampicillin was started, followed by close monitoring of her respiration status and circulation. By the next day, the uvular swelling was markedly improved, and the stridor and retraction were resolved. A throat culture taken at the initial examination grew Group A Streptococcus (GAS).

In literature, the major causes of uvulitis are Haemophilus influenzae type b (Hib) and GAS [[1], [2], [3], [4]]. Hib infections have nearly been eradicated due to widespread vaccination, making GAS the most frequent cause these days. GAS-induced uvulitis is commonly seen in children older than five years and clinically manifests as moderate fever (<39℃) with concomitant pharyngotonsillitis, and no respiratory distress [2]. As this was a quite atypical case for GAS-associated uvulitis, the possibility of a positive throat culture in a carrier state cannot be completely ruled out. Nevertheless, the marked improvement of the uvular swelling following the treatment with antimicrobials strongly suggests that the uvulitis was caused by an acute GAS infection.

It is extremely rare in children that uvulitis causes respiratory distress from airway obstruction [2,4]. However, narrow airways in infants may increase the risk of severe uvulitis progressing to respiratory distress. Physicians should be alert for possible indications of the need for emergency airway management. The lack of recent literature on this topic points to the need for updated information on prevalence, outcomes, and treatment.

Funding

None.

Consent

Written informed consent was obtained from the patient for publication of this case report and the accompanying image. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

CRediT authorship contribution statement

Yuya Morooka: Writing - review & editing, Writing - original draft. Kenji Furuno: Writing - review & editing, Data curation.

Declaration of Competing Interest

None.