Life threatening acute epiglottitis in acute leukemia

Area of Science:

• Oncology
• Infectious Diseases
• Pediatrics

Background:

• Acute epiglottitis is a rare but severe complication in pediatric cancer patients, particularly during chemotherapy.
• Acute promyelocytic leukemia treatment can increase susceptibility to life-threatening infections.
• Immunocompromised status in cancer patients necessitates vigilant monitoring for opportunistic infections.

Observation:

• An 8-year-old boy developed acute epiglottitis during induction chemotherapy for acute promyelocytic leukemia.
• The patient survived following emergency tracheostomy, broad-spectrum antibiotics, amphotericin, and granulocyte-macrophage colony-stimulating factor.
• No specific causative organism was identified in this case.

Findings:

• A literature review revealed 18 cases of acute epiglottitis in cancer patients, predominantly adults (15/18) with hematologic malignancies.
• Unlike typical epiglottitis, Haemophilus influenzae was not identified in any reported cancer cases.
• Streptococcus pneumoniae and Candida albicans were the most common pathogens identified in cancer-associated epiglottitis.

Implications:

• Early recognition and aggressive supportive care, including airway management and antimicrobial therapy, are crucial for managing acute epiglottitis in cancer patients.
• The distinct microbiological profile in cancer patients suggests different diagnostic and treatment approaches may be warranted.
• This case underscores the importance of considering rare infections in immunocompromised pediatric patients undergoing intensive cancer therapy.