When Adult Epiglottitis Does Not Improve With Intravenous Therapy: Think Epiglottic Abscess

Epiglottic abscess is a rare but potentially life-threatening complication of adult epiglottitis. Although airway compromise is a major concern, some patients may initially present with preserved airway patency despite significant supraglottic infection. We report the case of a 42-year-old woman who presented with a three-day history of worsening sore throat, dysphagia, odynophagia, fever, and inability to tolerate oral intake. Flexible nasendoscopy demonstrated marked supraglottic oedema and epiglottic enlargement without immediate airway compromise. Initial treatment with intravenous antibiotics, corticosteroids, analgesia, and supportive care resulted in minimal clinical improvement. Contrast-enhanced CT of the neck subsequently demonstrated a 3 cm rim-enhancing abscess within the epiglottis. The patient underwent microlaryngoscopy and operative drainage under general anaesthesia, with good postoperative recovery. This case highlights the importance of reconsidering the diagnosis in adult epiglottitis that fails to improve with medical therapy, even in the absence of overt airway obstruction. Early imaging and timely surgical intervention may be crucial in preventing further deterioration.