Atypical Acute Epiglottitis Identified During Emergency Intubation: A Case Report

Acute epiglottitis in adults can be difficult to recognize when classic upper-airway symptoms are absent and a competing cardiopulmonary process is present.A woman in her late 70s with hypertension and diabetes presented with progressive dyspnea, hoarseness, non-productive cough, orthopnea, bipedal edema, and hypoxemia.She was afebrile and denied odynophagia, dysphagia, or drooling.Stridor was absent on examination.Pneumonia and possible acute decompensated heart failure were initially considered.Despite oxygen therapy, her work of breathing worsened.During rapid sequence intubation, video laryngoscopy unexpectedly demonstrated marked epiglottic and supraglottic edema.An initial 7.5 mm endotracheal tube could not be passed.The otorhinolaryngology service was called and stood by for a surgical airway, after which a 7.0 mm tube was successfully placed without documented peri-intubation complications.Endotracheal aspirate subsequently yielded light growth of Klebsiella pneumoniae in the setting of concurrent pneumonia, although the lower respiratory tract source precluded definitive attribution of the supraglottic infection to this organism.The patient improved with antimicrobial therapy, corticosteroids, ventilatory support, and glycemic management and was discharged without recurrent airway symptoms.This case highlights the need to reconsider upper-airway pathology when progressive respiratory distress is accompanied by hoarseness or unexplained voice change, even when cardiopulmonary findings appear to provide an alternative diagnosis.