Vaping-Induced Acute Epiglottitis: A Case Report

Abstract

Abstract Background: E-cigarette use or vaping, is an alternative nicotine delivery system that is becoming increasingly prevalent in the adolescent and young adult population. There is currently a lack of comprehensive research on the adverse effects of vaping on the upper airway. Acute epiglottitis is a potentially life-threatening condition that can lead to airway obstruction. It is most commonly caused by bacterial infections such as streptococci, staphylococcus, and Moraxella. Adult patients with acute epiglottitis mainly present with odynophagia, dysphagia, and respiratory difficulties. The diagnosis of epiglottitis is made by direct laryngoscopy, and the mainstay of treatment is antibiotics. Bozella et al. reported a case of subacute non-infectious epiglottitis associated with e-cigarette use in a pediatric patient. Here we present a case of acute epiglottitis in a healthy young adult after vaping, with a negative infectious investigation. To our knowledge, there has been no such reported case of epiglottitis associated with e-cigarette use in an adult patient. Case description: A previously healthy 29-year-old male with daily e-cigarette use presented to the emergency department with a severe sore throat, dysphagia, mild hoarseness, and shortness of breath especially when lying supine. A lateral neck soft tissue radiograph revealed a thickened epiglottis with a thumb sign. Direct bedside laryngoscopy showed a swollen epiglottis, partially obstructing the supraglottic region confirming the diagnosis of acute epiglottitis. A throat swab was negative for streptococcus infection. The patient received intravenous dexamethasone and antibiotics for two days and improved significantly. Repeat laryngoscopy showed the resolution of epiglottis swelling and patients’ symptoms had completely resolved two weeks after start of treatment. Conclusions: Even though bacterial infections usually cause acute epiglottitis, this case presents the second report of this condition associated with vaping with negative microbiological investigations. Therefore, we recommend physicians consider non-infectious causes such as vaping in their differential diagnosis in patients presenting with acute and subacute epiglottitis. More research is warranted on the utility of antibiotics for the treatment of vaping-induced epiglottitis.