Emphysematous Epiglottitis in an Immunocompromised Adult with Unusual Pathogens: A Case-Based Literature Review

Abstract

Emphysematous epiglottitis is a rare, potentially life-threatening complication of acute epiglottitis, characterized by gasforming infection of the epiglottis. While commonly associated with pediatric populations, epiglottitis can also occur in immunocompromised adults and may present atypically. We report a case of a 57-year-old man with poorly controlled Type 2 diabetes mellitus and end-stage renal failure who initially presented with typical symptoms of epiglottitis. Flexible laryngoscopy revealed a swollen epiglottis with overlying pustules. Computed tomography (CT) of the neck demonstrated gas loculi within the epiglottis, consistent with emphysematous transformation and abscess formation.

The patient underwent urgent airway protection via fiber-optic intubation followed by incision and drainage of the abscess. Cultures yielded Streptococcus parasanguinis and Candida albicans. Following targeted antimicrobial therapy and corticosteroids, the patient made a full recovery. This case highlights the diagnostic value of CT in detecting emphysematous epiglottitis and emphasizes the need for radiologists to recognize this rare but emergent condition, particularly in high-risk patients.