Search

Thermal epiglottitis, a non-infectious cause of epiglottitis, is a rare entity that shares some clinical features with infectious epiglottitis. This study presents 16 years of experience in diagnosing and managing thermal epiglottitis. A retrospective descriptive study in a tertiary center in southern Israel included confirmed cases of thermal epiglottitis in children (0-18 years) between 2004 and 2020 by endoscopy. Of approximately 600,000 pediatric ER admissions between 2004 and 2020, seven children were diagnosed by endoscopy with thermal epiglottitis (mean age 24 months, 71% males). Clinical presentation included stridor, respiratory distress, and drooling. Four children had fever and elevated inflammatory markers at presentation and were treated with systemic antibiotics. All were treated with systemic steroids. The median length of stay in the PICU was five days, and four patients required intubations. All fully recovered without experiencing any sequelae.  Conclusion: Thermal epiglottitis stands as a potential contributor to acute upper airway obstruction. Although it's rarity, it should be discussed in any child with acute upper airway obstruction. It is essential to inquire directly about the accidental intake of hot beverages, particularly in cases lacking fever or elevated inflammatory markers. What is Known: • Thermal epiglottitis is a rare, non-infectious condition sharing clinical features with infectious epiglottitis. • Common presentations include stridor, respiratory distress, and drooling. What is New: • Thermal epiglottitis is a potential contributor to acute upper airway obstruction, urging consideration even in the absence of fever or elevated markers. • Direct inquiry about hot beverage intake for diagnosis is essential for diagnosis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The purpose of this study was to investigate the clinical characteristics and risk factors of adult recurrent acute infectious epiglottitis. Methods: All patients diagnosed with acute infectious epiglottitis hospitalized in the Department of Otolaryngology, Hai'an People's Hospital, Nantong University from January 2012 to December 2019 were included. Results: The recurrence rate of 331 adult patients with acute infectious epiglottitis was 4.2% （14/331）, including 10 cases of once recurrence and 4 cases of twice recurrence. The onset time of all patients was within 48 hours. The most common main complaint in the recurrent group was sore throat （42.9%）, and dysphagia in the non-recurrent group （42.0%）. The frequency of drinking in recurrent group was higher than that in non-recurrent group （ P =0.009）. The incidence of chronic obstructive pulmoriary disease（COPD）, diabetes, cyst and gastroesophageal reflux disease/laryngopharyngeal reflux disease in recurrent group was higher than that in non-recurrent group. There was no significant difference in other clinical features, treatment and prognosis between the two groups except tongue tonsil infection under laryngoscope. Multivariate analysis showed that frequent drinking （more than twice a week）, COPD, diabetes, cysts and lingual tonsillar infection were the risk factors for recurrence. Conclusion: Adult acute infectious epiglottitis has a proportion of single or multiple recurrence. Frequent drinking, COPD, diabetes, cyst and lingual tonsillar infection are the risk factors for the recurrence., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Acute sore throat is one of the most common problems in general practice. It usually concerns a viral oropharyngeal infection, with good recovery within 10 days. In current guidelines, antibiotics are recommended only in exceptional situations. Although rare, potentially life-threatening complications can occur. Three case histories, on epiglottitis, peritonsillar abscess, and Lemierre syndrome, respectively, demonstrate that acute sore throat can result in severe illness. Early recognition of alarm symptoms, alertness on a complicated disease course, and clinical (re)evaluation (within 1-2 days), are essential. This contributes to the differentiation between a harmless and a serious course, given that serious conditions also have an innocent onset. We highly recommend to consult an ENT specialist when there is doubt about the seriousness of the disease, or correctness of therapy, so timely co-assessment, treatment or transfer can follow. ECMO can be a life-saving treatment when conventional therapy is insufficiently supportive.

Introduction: Adult epiglottitis is a serious condition that carries with it a high rate of morbidity and even mortality due to airway occlusion., Objective: This review highlights the pearls and pitfalls of epiglottitis in adult patients, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence., Discussion: Epiglottitis is a life-threatening emergency that occurs more commonly in adults in the current medical era with vaccinations. Children present more commonly with acute respiratory distress and fever, while adults present most commonly with severe dysphagia in a subacute manner. Other symptoms may include drooling, muffled voice, and dyspnea. Streptococcus and Staphylococcus bacteria are the most common etiologies, but others include viral, fungal, caustic, thermal injuries, and autoimmune. Lateral neck radiographs assist in diagnosis, but they may be falsely negative. Visualization of the epiglottis is the key to diagnosis. Airway assessment and management are paramount, which has transitioned from direct laryngoscopy to flexible intubating endoscopy and video laryngoscopy with assistance from anesthesia and/or otolaryngology if available. Along with airway assessment, antibiotics should be administered. Corticosteroids and nebulized epinephrine are controversial but should be considered. Patients should be admitted to the intensive care setting for close airway observation or ventilatory management if intubated., Conclusions: An understanding of epiglottitis can assist emergency clinicians in diagnosing and managing this potentially deadly disease., Competing Interests: Declaration of Competing Interest None., (Published by Elsevier Inc.)

Background: In humans, coronavirus disease 2019 (COVID-19) has a variable presentation ranging from mild self-limiting respiratory tract infections to severe acute respiratory distress syndrome. Methods: We present the case of a patient who developed acute epiglottitis after surgery for an intracranial tumour and was subsequently diagnosed with COVID-19., Results: A 58-year-old female patient developed acute-onset respiratory distress on day 6 after intracranial surgery. Neck computed tomography revealed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis. The patient's SARS-CoV-2 polymerase chain reaction test was positive. Viral respiratory tract panel and sputum and blood cultures were negative. She completed the antiviral and antibacterial treatment regimens recommended by the chest disease department., Conclusions: We conclude that epiglottitis can be an unusual manifestation of COVID-19.

Abstract: Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticosteroid. Uvulitis is usually caused by group A Streptococcus or Haemophilus influentiae, but also other bacteria can be detected. Uvulitis can be isolated, or it can occur with epiglottitis and become an emergency., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

There have been more than 178 million global cases of COVID-19, the disease caused by the SARS-CoV-2 virus, with more than 3.8 million deaths worldwide [1]. COVID-19 can present with a wide variety of symptoms, and one rare manifestation that has been reported in the literature is acute epiglottitis. To date, there have been two reported cases of acute epiglottitis in COVID-19 positive patients [2, 3]. We present a case of a 49-year-old male presenting to a community emergency department with the chief complaint of dysphagia and sore throat, confirmed as acute epiglottitis, in the presence of a positive rapid COVID-19 PCR test., Competing Interests: Declaration of Competing Interest None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To identify contributive criteria in decision-making for intubation in acute epiglottitis, based on clinical and endoscopic data in adult patients, and to study clinical and biological characteristics and management., Materials and Methods: Diagnosis was established by flexible endoscopy showing epiglottic edema in association with general signs of sepsis in 28 patients consulting into two French hospitals between 2005 and 2016. Retrospective univariate and multivariate analysis between patients managed by intubation (Group I) or surveillance (Group S) was performed on clinical and endoscopic data., Results: Ten patients were intubated (36%). On univariate analysis, 4 variables were suggestively associated with intubation. On multivariate analysis, associations remained suggestive for dyspnea (OR=50.6; 95% CI=[2.7; 940.1]) and supraglottic edema extension (OR=42.2; 95% CI=[2.2; 799.5]). The area under the curve identifying intubated patients on these 2 criteria was 90.8%, testifying to high discrimination., Conclusion: Intubation must always be considered in epiglottitis. Dyspnea and supraglottic extension of the edema seem to be the two main criteria to be considered in airway control decision-making., (Copyright © 2020. Published by Elsevier Masson SAS.)

Objective: The objective is to reduce the rates of misdiagnosis and inappropriate treatment of laryngeal tuberculosis (LTB)., Study Design: Retrospective case series., Materials and Methods: Medical records of 3 histopathology-confirmed cases at a tertiary medical center from 2000 to 2018., Results: Seventeen patients with LTB included in this study. Of the 17 patients, 16 patients were male and 1 was female; 11 patients had a history of smoking. Odynophagia was the chief complaint in 6 cases, and 11 patients complained of hoarseness. The appearance of the affected larynx was ranged from diffuse swelling (n = 7, 41.2%), mucosa white lesion (n = 5,29.4%), and granulomatous tumors (n = 2, 11.76%), and these features presented together (n = 2, 11.76%). Seventeen patients with LTB were misdiagnosed as acute epiglottitis in 4 (23.5%) patients, acute laryngitis in 1 (5.9%) patient, leukoplakia in 5 (29.4%) patients, laryngopharyngeal reflux (LPR) in 6 (35.3%) patients, and laryngocarcinoma in 1 (5.9%) patient. Chest computed tomography reported old pulmonary tuberculosis in 2 (11.7%) patients, active pulmonary tuberculosis in 7 (41.2%) patients, and normal lung status in 8 (47.1%) patients. Histopathological examination reported Mycobacterium tuberculosis infection by revealing epithelioid cell granulomas with Langhans-type giant cells in 14 (82.4%) patients and epithelioid cell granulomas with caseous necrosis and Langhans-type giant cells in 3 (17.6%) patients., Conclusions: Laryngeal tuberculosis was easily misdiagnosed as acute epiglottitis or leukoplakia because of diffuse swelling of the epiglottis or white lesions over the true vocal cord, especially patients with increasing LTB were misdiagnosed as LPR with the enhancement of LPR awareness among otolaryngologist. Clinicians should be aware of the possibility of LTB for chronic intractable laryngitis with failure treatment of proton pump inhibitor and recurrent acute epiglottitis with foreign body injury.

Case Presentation: A 68-year-old woman was referred for immunological investigation following an episode of meningococcal epiglottitis with associated septicaemia. Several years previously, she had been diagnosed with undifferentiated connective tissue disease. On investigation, alternative pathway complement function was normal; however, classical pathway complement activation was reduced. C1q, C3 and C4 levels were all measured and found to be within their respective normal ranges, but C2 levels were low. Sequencing of the C2 gene was subsequently performed, confirming a diagnosis of type 1 C2 deficiency (C2D)., Discussion: C2D is usually hereditary and inherited in an autosomal recessive manner. C2D is often asymptomatic, however, some patients suffer from infections with encapsulated bacteria and/or autoimmune diseases, particularly systemic lupus erythematosus. Recognition of complement pathway deficiency is important due to the predisposition to severe and/or recurrent infections by encapsulated bacteria. Immunisations have the potential to reduce both mortality and morbidity not only for the patient but also for any affected relatives., (© Royal College of Physicians 2021. All rights reserved.)

Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Apart from cases related to direct inoculation, pasteurellosis is a rare opportunistic infection occurring in predisposed subjects. Close contact with domestic animals, usually cats, is generally reported. Localized ENT forms are possible and are due to oropharyngeal carriage., Case Report: We present the case of a patient with no notable history, who presented with laryngeal dyspnea and hyperthermia leading to a diagnosis of acute epiglottitis. Bacteremia was detected and blood cultures were positive for Pasteurella multocida. Treatment consisted of the standard treatment for acute epiglottitis with hospitalisation and intravenous antibiotics., Discussion: This patient presented a history of animal exposure, but no other known risk factors. The activity spectrum of antibiotic therapy for epiglottitis should include H. influenzae and this case illustrates the diversity of the micro-organisms potentially involved. Immunosuppression or another chronic disease does not appear to be a prerequisite for ENT infection., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate the incidence of acute epiglottitis (AE) and the clinical features of patients with AE complicated by peritonsillar abscess (PTA), considering that PTA, especially inferior-type PTA, is often a comorbidity of AE., Methods: We retrospectively reviewed the medical records of patients who were diagnosed as having AE by otolaryngologists and referred to our hospital between January 2009 and December 2017. All the patients underwent laryngeal endoscopy and contrast-enhanced computed tomography (CT) for examination of the severity of AE and its complications by other infections, including PTA. The clinical characteristics of patients with PTA were compared with those of patients without PTA., Results: A total of 139 patients were enrolled, of whom 21 (15%) were found to have PTA. Among the 21 patients, only one had a superior-type PTA and the others had an inferior-type PTA. The patients with complicated AE by an inferior Cap-type PTA frequently showed unilateral arytenoid swelling., Conclusion: PTA is a comorbidity of AE, and unilateral arytenoid swelling is considered to suggest the presence of inferior-type PTA., (Copyright © 2020. Published by Elsevier B.V.)

Necrotizing epiglottitis (NE) is a rare but extremely serious variant of acute bacterial epiglottitis. So far, it has been reported mostly in immunocompromised adults and only seldomly in the pediatric population. We describe the case of a 15-month-old immunocompetent child who presented to our tertiary referral center with necrotizing epiglottitis. This manuscript emphasizes the need for rapid recognition and surgical management of this unusual condition, as well as the importance of laryngeal preservation when facing overwhelming necrosis around the laryngeal cartilaginous framework. A review of the literature using MEDLINE, Embase and Web of Science databases was performed to discuss the epidemiology, bacteriology, treatment and prognosis of NE., (Copyright © 2020 Elsevier B.V. All rights reserved.)

An adolescent female patient presenting with subacute onset of dysphagia and hoarseness underwent a direct laryngoscopy, which revealed epiglottitis. After 2 hospitalizations and multiple consultations and biopsies, all infectious testing results for viral, bacterial, fungal, and acid-fast bacilli etiologies were negative. The patient's use of electronic cigarettes was the only exposure elicited with a likely role in her presentation. This case, combined with the growing body of evidence revealing the toxic effects of vaping and the increasing use of electronic cigarettes among adolescent patients, highlights the many unknowns and risks regarding the biological effects of this practice., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Background: Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis., Case Presentation: We report on a case of sudden and unexpected death in an 8-year-old female who was diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but no evidence of acute inflammation., Conclusion: Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy.

Acute infectious epiglottitis is infrequent at present due to vaccination for its main etiologic agent, Haemophilus influenzae b (Hib). It must be taken into account when we make a differential diagnosis in a child whose clinical symptoms are respiratory distress, stridor, dysphonia and fever. We report a 2-year-old child, previously healthy, whose vaccination calendar was complete, and whose clinical presentation included respiratory distress and stridor; at the moment of the intubation the laryngoscopy showed an acute epiglottitis. Blood cultures were taken, which were positive for Hib. He was treated with ceftriaxone during 13 days, and the control blood cultures and cerebrospinal fluid were negative., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

We present a case of acute Candida epiglottitis in an otherwise healthy and Haemophilus influenzae type B-immunized 4-year-old child. A query of the literature reveals this disease to be commonly found in patients who are immunocompromised by problems including human immunodeficiency virus disease and lymphoma and leukemia. However, there are no published reports of acute Candida epiglottitis in immunocompetent and vaccinated patients. Our case should emphasize to the emergency physician the need to remain vigilant for subtle and atypical presentations of airway-destabilizing diseases.

Infection of the neck is a relatively common emergency department complaint. If not diagnosed and managed promptly, it may quickly progress to a life-threatening infection. These infections can result in true airway emergencies that may require fiberoptic or surgical airways. This article covers common, as well as rare but emergent, presentations and uses an evidence-based approach to discuss diagnostic and treatment modalities., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This article reviews the presentation, diagnosis, and management of common and "can't miss" infections of the oropharynx, including streptococcal pharyngitis, infectious mononucleosis, peritonsillar abscess, retropharyngeal abscess, and epiglottitis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The type of scalding injury known as 'teapot syndrome', where hot liquid is grabbed by the child with the aim of ingestion and falls over a child causing burns on the face, upper thorax and arms, is known to cause peri-oral and facial oedema. Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion of a damaging agent or intraoral burns, Awareness of the possibility of thermal epiglottitis, also in scald burns, is imperative to ensure prompt airway protection., Case Presentation: We report the case of a child with thermal epiglottitis after a scalding burn from boiling milk resulting in mixed deep burns of the face, neck and chest, but no history of ingestion. Upon presentation there was a progressive stridor and signs of respiratory distress requiring intubation. Laryngoscopy revealed epiglottis oedema, confirming the diagnosis of thermal epiglottitis. Final extubation took place 5 days after initial burn., Conclusions: Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion and intra-oral damage. Burns to the peri-oral area should raise suspicion of additional damage to oral cavity and supraglottic structures, even in absence of intra-oral injury or initial respiratory distress. Awareness of the occurrence of thermal epiglottitis in absence of intra-oral injury is important to diagnose impending upper airway obstruction requiring intubation.

Objective: Necrotizing supraglottitis is a rare but potentially morbid infection most often seen in immunocompromised patients. All reported cases have utilized intravenous antibiotic therapy as the mainstay of treatment and many have had associated morbidities., Methods: We describe a case of a 50-year-old previously healthy female who presented with necrotizing epiglottis and was treated with immediate surgical debridement followed by directed antibiotic therapy., Results: Our patient rapidly recovered with no further invasive interventions. On follow up she had no further complications or functional deficits., Conclusions: Although uncommon, providers should be aware of the potential benefits of early debridement when treating patients with similar pathology. Early surgical intervention should be considered to avoid local tissue loss, airway interventions, and long-term sequelae., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia., Methods: Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed., Results: Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury., Conclusion: Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection., (© 2018 Royal Australasian College of Surgeons.)

Objective: Studies have revealed that 3.5%-26.6% of patients with epiglottitis have comorbid diabetes mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains unclear. In this study, our aim was to explore the relationship between preexisting DM and acute epiglottitis in different age and sex groups by using population-based data in Taiwan., Methods: We analyzed data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. The case group consisted of 2,393 patients with acute epiglottitis. The control group comprised 9,572 individuals without epiglottitis, frequency matched by sex, age, urbanization level, and income. Underlying DM was retrospectively assessed in the cases and controls. Univariate and multivariate logistic regression analyses were used to investigate the associations between underlying DM and acute epiglottitis., Results: Of the 2,393 patients, 180 (7.5%) had preexisting DM, whereas only 530 (5.5%) of the 9,572 controls had preexisting DM. Multivariate logistic regression analyses indicated that preexisting DM was significantly associated with acute epiglottitis (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = 1.15-1.75, P = 0.004). Subgroup analysis showed that the association between DM and epiglottitis remained significant for men (aOR = 1.57, 95% CI: 1.19-2.08, p = 0.002) but not for women. Age-stratified analysis revealed a significant association between DM and acute epiglottitis in patients aged 35-64 years. Use of anti-diabetic agents was not significantly associated with the development of acute epiglottitis among diabetic patients, including oral hypoglycemic agents (OHA) alone (aOR = 0.88, 95% CI = 0.53-1.46, p = 0.616), and OHA combined with insulin/ insulin alone (aOR = 1.30, 95% CI = 0.76-2.22, p = 0.339). The association between presence of diabetes complications and the occurrence of acute epiglottitis was also not significant among diabetic patients in this study setting (aOR = 0.86, 95% CI = 0.59-1.26, p = 0.439)., Conclusions: The results of our large-scale population-based case-control study indicate that preexisting DM is one of the possible factors associated with the development of acute epiglottitis. Physicians should pay attention to the symptoms and signs of acute epiglottitis in DM patients, particularly in men aged 35-64 years., Competing Interests: The authors have declared that no competing interests exist.

Rationale: Acute epiglottitis is a potentially life-threaten disease, which makes it more challenging to save the life for doctors. Unexpected deaths in custody are a primary cause of concern for the forensic community and doctor worldwide., Patient Concerns: We present a case of a 44-year-old male detainee who was clinically suspected of dying of acute epiglottitis. The man experienced failure of resuscitation and died after admitted to a hospital., Diagnoses: The autopsy, toxicological testing, the test of immunoglobulin E and bacterial culture suggested the patient died of acute epiglottitis., Interventions: The bacterial culture was performed to imprecisely identify the cause of death., Outcomes: The bacterial culture of the patient's heart blood and nasal and throat swabs showed the presence of the pathogenic microorganism Haemophilus influenza type B., Lessons: We aim to provide a reference to the medical and forensic community and remind the local law enforcement agencies on the problems present within the correctional healthcare system through this case report. Additionally, we also aim to increase the current knowledge and understanding on custodial deaths caused by natural diseases.

Epiglottitis is a rarely encountered infection in pediatrics since the advent of the conjugate Haemophilus influenzae type b vaccine first introduced in the United States in 1985. However, the disease remains a much feared infection in pediatrics. The literature reiterates the importance of early recognition, avoidance of agitating the patient, and the need for securing the airway in the operating room as key and essential features to a good outcome. However, with only 1 case per 200,000 children reported in the United States in 2006, most practitioners have never encountered this infection. The following is a case of a previously healthy and immunized child who presented to our emergency department and whose condition was ultimately diagnosed as epiglottitis.