SHM Converge Scientific Abstract ePoster Gallery-An Atypical Case of Infectious Mononucleosis Causing Acute Epiglottitis

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A 23-year-old man with no significant past medical history presented to the emergency department with one week of severe sore throat and dysphagia. His symptoms included raspy voice, odynophagia worsened by swallowing and head movement, chills, headache, nausea, and right-sided facial/neck pressure. He also had inspiratory stridor and right anterior cervical lymphadenopathy. Social history was notable for cigarette and marijuana use, daily beer intake, recent oral sex, and prior IV drug use.<br /><br />Initial infectious workup was negative for respiratory PCR, blood cultures, HIV, hepatitis C, and syphilis. However, heterophile antibody testing was positive, and abdominal ultrasound showed mild splenomegaly, supporting infectious mononucleosis. Flexible laryngoscopy revealed acute epiglottitis with severe laryngitis, and CT neck confirmed bilateral aryepiglottic fold edema, worse on the right, with supraglottic narrowing and reactive cervical nodes.<br /><br />He was treated inpatient with IV dexamethasone, ceftriaxone, humidified oxygen, hydration, analgesics, antipyretics, and rest. He remained stable and was closely monitored because of the risk of airway compromise.<br /><br />The case highlights that epiglottitis is a potentially life-threatening inflammatory process that can rapidly obstruct the upper airway. While common infectious causes include Hib, Streptococcus pneumoniae, Group A Streptococcus, and Staphylococcus aureus, noninfectious causes and atypical infections should also be considered. Infectious mononucleosis usually presents with fever, pharyngitis, adenopathy, fatigue, and splenomegaly, but EBV-related mononucleosis can rarely be associated with acute epiglottitis. This case emphasizes the importance of detailed history, prompt airway assessment, ENT involvement, and maintaining a broad differential diagnosis in patients with sore throat and signs of upper airway involvement.

Asset Subtitle

Shijo Benjamin

Meta Tag

Author List Heather E. Ragozine-Bush, John Nawrocki, Shijo Benjamin

Category Clinical Vignettes

Concept Acute Epiglottitis

Concept Airway Compromise

Concept Stridor

Concept Flexible Laryngoscopy

Concept Epstein-Barr virus infectious mononucleosis

Distinguished Non-Finalist

Presenter Organization Geisinger Commonwealth School of Medicine

Presenting Author Shijo Benjamin

Track Adult

Keywords

epiglottitis

infectious mononucleosis

EBV

sore throat

dysphagia

stridor

laryngitis

airway compromise

cervical lymphadenopathy

dexamethasone

Acute Epiglottitis

Airway Compromise

Stridor

Flexible Laryngoscopy

Epstein-Barr virus infectious mononucleosis