Lesson of the Week: Adult epiglottitis: prompt diagnosis saves lives

Case 1

In July 1990 a 35 year old white man referred himself to the emergency department on a weekday afternoon, having suffered for five days with a sore throat that had started two days after returning from holiday in Portugal. In the morning the pain had increased and he had difficulty in swallowing and had experienced rigors. The triage nurse observed that he had a painful throat and was shaking. He had a high fever (39.4°C) and was noted to be only mildly distressed. His pharynx was inflamed, with minimal tonsillar enlargement; he had bilateral upper cervical lymphadenopathy. A senior house officer diagnosed a bacterial upper respiratory tract infection. Despite the history of rigors no blood cultures or throat swabs were taken, and the patient was discharged with phenoxymethyl-penicillin 500mg to be taken four times daily, having been advised to see his …