Title: A Rare Case of Pasteurella Epiglottitis
Author(s): Katherine Mitry, MD
Email: kmitry@mercy.com
Introduction: Infectious epiglottitis is a life-threatening inflammatory infection of the epiglottis and surrounding upper airway that may lead to respiratory arrest if untreated. Pasteurella multocida is a gram-negative coccobacillus that most commonly colonizes the respiratory system of cats and dogs and is also a rare cause of epiglottitis. I present a case of Pasteurella multocida epiglottitis diagnosed in an adult leading to acute respiratory failure. To the best of my knowledge, this is the 17th case reported in the literature.
Case Report(s): A 64 y/o male with a past medical history of HTN, CAD, DM, OA, former 1 PPD cigarette smoker 16 years ago and significant surgical history of tonsillectomy in 2010 presented to the emergency department with complaints of throat pain for 1 month with associated productive cough, odynophagia, and shortness of breath. His initial vitals showed BP 79/82, HR 144, RR 22, O2 sat 95% on RA, Temp 98.8F. His initial exam showed an ill-appearing non-toxic male in no acute distress. GCS 15. His posterior oropharynx appeared erythematous, uvula midline, airway grossly patent. Neck was tender to palpation bilaterally. Lung sounds were clear bilaterally and he was not in respiratory distress. Heart was tachycardic and irregularly irregular, which was new-onset. Exam was otherwise unremarkable. Labs significant for WBC 21.4 with left shift, lactic acid 10.4, strep negative. The patient was given 3L bolus of fluids and 10 mg IV Decadron. On re-examination the patient’s O2 sat declined to 56% on RA and he appeared grey with labored breathing and accessory muscle use. He was grabbing at his throat indicating that he couldn’t breathe. Breath sounds remained clear. Patient was given ketamine and etomidate for intubation. Upon insertion of the Glidoscope, the epiglottis was noted to be very erythematous and edematous. Anesthesia was called and the patient was ultimately intubated with a 6.5 cuffed ET tube. Blood cultures were obtained. He was initially given Ceftriaxone and Vancomycin and admitted to the ICU. ID and ENT were consulted. Blood cultures grew gram negative rods identified as Pasteurella Multocida on day 3 and antibiotics were adjusted to include Unasyn instead of Rocephin.
: Pasteruella multocida is a rare cause of epiglottitis with only 16 other case reports described in the literature. It is a gram-negative coccobacillus that is part of the normal flora of the mouth and upper respiratory tract of many animals, particularly cats and dogs. Most patients with Pasteurella multocida respiratory tract infections have underlying lung disease or risk factors such as immunocompromise, lack of immunization, or smoking. In addition, there is likely exposure to cats or dogs. My patient did have risk factors such as prior history of smoking and was noted to have a cat and dog at home. Although epiglottitis is rare in adulthood, physicians should keep this differential in mind for patients presenting with sore throat, dysphagia, odynophagia due to the potential for rapid respiratory failure requiring airway management. In addition, Pasteurella multocida is a rare but possible cause and can be diagnosed by blood culture.
