Wednesday, June 25, 2008

Thumb's Up

A three year old child is brought in by parents with abrupt onset fever (39.5C), sore throat, dysphagia, and drooling. This has only been going on for the last 12 hours, but the child looks toxic. WBC is elevated at 25,000/mm3 with increased neutrophils and bands. The child complains that he can't breathe and feels like choking when he inspires. He is anxious, restless, irritable, and his speech is muffled but not hoarse. The child is sitting with his arms back, trunk leaning forward, neck hyperextended, and chin thrust forward. No stridor is heard. The child has not received any vaccinations.

Challenge: What is the causative agent?

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Alex said...

tonsillitis? mumps? (think you did that already)

the no vaccination thing makes it sound like one of the childhood diseases

Craig said...

Thumb’s Up

This is a classic presentation of epiglottitis, most likely caused by H. influenzae. This should be suspected in a child with the characteristic sitting position, anxiety, drooling, sore throat, dysphagia, and inspiratory distress without stridor. The lateral neck radiograph shows the “thumb” sign (red arrow), an enlarged epiglottis. The white arrow is a thickened aryepiglottic fold. Also note that the cervical spine is straightened instead of the usual cervical lordosis.

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