Epiglottitis in Patients Treated for Acute Leukemia: Case Series and Systematic Review of the Literature.

Abstract

Introduction: Acute epiglottitis is a medical emergency characterized by inflammation of supraglottic structures of the larynx and epiglottis. The clinical characteristics and course of this complication in acute leukemia (AL) are largely unknown. We present a case series and a systematic review of the literature of adult patients with AL and acute epiglottitis.

Case presentation: Four patients with acute myeloid leukemia (age 38-61 years) were diagnosed with acute epiglottitis during their intensive treatment course. One patient presented with epiglottitis at the end of induction, two at the end of consolidation therapy, and 1 patient presented with a later event. Three patients were in grade 4 neutropenia during infection onset (median aplasia duration to event 9 [range 4-14] days). All patients presented with neck pain and dysphagia and 2 patients also had dyspnea at presentation. Urgent invasive airway protection was required in 3 patients. Two patients died due to this complication, one suffered anoxic brain injury. A systematic literature review identified 8 additional cases of epiglottitis.

Conclusion: Acute epiglottis is a rare but significant medical emergency with unique challenges in the setting of AL that is caused by atypical infectious pathogens. Early detection and a multidisciplinary therapeutic effort are crucial to improve patient outcome.