Female With Fever and Sore Throat

Article Outline

• Diagnosis
  • Epiglottitis
• Copyright

[Ann Emerg Med. 2008;52:573.]

A 24-year-old woman presented to the emergency department with a 1-day history of fever, sore throat, and odynophagia. Patient vital signs included a temperature of 37.8°C (100°F), a pulse rate of 99 beats/min, and a blood pressure of 116/71 mm Hg. She had a normal-appearing oropharynx on examination. A lateral neck radiograph showed thickening of the epiglottis (Figure 1).

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• Figure 1. 

  Radiograph at initial emergency department presentation.

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Diagnosis 

Epiglottitis 

The radiograph showed findings consistent with epiglottitis. Subsequent bedside laryngoscopy by the consulting otolaryngology service confirmed the diagnosis of epiglottitis.

The patient was treated with intravenous dexamethasone and ampicillin/sulbactam. She was admitted to the ICU for airway monitoring. One day later, the patient left the hospital against medical advice. She returned 3 days later and received repeated imaging (Figure 2). The repeated lateral radiograph shows nearly complete resolution of edema. With the advent of the Haemophilus influenzae type b vaccine, acute epiglottis needs to be considered in the adult patient presenting with a complaint of sore throat, odynophagia, and a normal oropharyngeal examination result.

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• Figure 2. 

  Follow-up radiograph. Used with permission of Marie Mullen, MD, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.