Role of nasopharyngoscopy in worsening pharyngitis.

CASE PRESENTATION

A 60‐year‐old man presented to the emergency department (ED) with a chief complaint of fever and worsening sore throat for 2 days. On the day prior, the patient was seen by his primary physician, diagnosed with uvulitis, and treated with intramuscular dexamethasone and ceftriaxone. Upon arrival to the ED, he reported worsening sore throat, fever, dysphagia, and trismus. Visualization of the oropharynx confirmed uvulitis (Figure 1), but because of the severity of his symptoms and his worsening “hot potato voice,” nasopharyngeal fibroscopy was performed at bedside and revealed concurrent severe epiglottitis (Figure 2).

FIGURE 1

Photograph of the patient's oropharynx demonstrating uvulitis

FIGURE 2

Laryngeal fiberoscopy demonstrating an edematous and inflamed epiglottis

DIAGNOSIS

Uvulitis with concurrent epiglottitis

After nasopharyngeal fibroscopy, the patient was treated with intravenous broad‐spectrum antibiotics and intravenous dexamethasone. Computed tomography was obtained and redemonstrated epiglottitis and uvulitis (Figure 3). The patient was admitted to the intensive care unit (ICU) for close airway monitoring, where serial nasopharyngeal fibroscopy revealed gradual improvement. The patient was ultimately discharged with oral antibiotics on day 3 of hospitalization.

FIGURE 3

(A) Axial and (B) sagittal computed tomography of the soft tissues of the neck demonstrating enlargement of the uvula and epiglottis

Epiglottitis and uvulitis frequently occur as the result of bacterial infections with Haemophilus influenzea, Streptococcus pyogenes, and Streptococcus pneumonia. , Although epiglottitis and uvulitis may have similar initial presenting symptoms, signs of more severe supraglottic inflammation, such as drooling, a muffled voice, and trismus, should prompt further investigation, including strong consideration for nasopharyngeal fibroscopy. All cases of epiglottitis require intravenous antibiotics and steroids, but mild cases without airway compromise may be admitted to an ICU and observed closely. , Advanced airway management may be required in up to 15% of patients.