edge in clinical features , immunological responses , and vaccine development . FASEB J . 2021 Mar ; 35 ( 3 ): e21409 . PMID : 33577115 ; PM- CID : PMC7898934 . https :// doi . org / 10.1096 / fj . 202002662R
2 . Orhan İ , Aydın S , Karlıdağ T . Infectious and Noninfectious Causes of Epiglottitis in Adults , Review of 24 Patients . Turk Arch Otorhinolaryngol . 2015 ; 53 ( 1 ): 10-14 . https :// doi . org / 10.5152 / tao . 2015.718
3 . Lichtor JL , Roche Rodriguez M , Aaronson NL , Spock T , Goodman TR , Baum ED . Epiglottitis : It hasn ’ t gone away . Anesthesiology . 2016 ; 124 ( 6 ): 1404-1407 . https :// doi . org / 10.1097 / ALN . 0000000000001125
Figure 2 . Additional image exhibiting cephalocaudal extent of abscess .
Review of literature shows that a few studies currently exist on the association between ithelial and endothelial damage caused by exduced cytokine storm , secondary to repeat ep-
acute epiglottitis and COVID-19 infection . One cessive upregulation of the host inflammatory case report pointed to the possibility of concurrent epiglottitis and COVID-19 infection being of behind their patient ’ s presentation with acute
response , could be the underlying mechanism
a noninfectious etiology , particularly secondary epiglottitis along with COVID-19 infection . 9 to e-cigarette use . The rationale posited was
Some limitations in this case study exist . related to a localized epiglottic inflammatory
Certain diagnostic tests that might have aided in response elicited by a combination of COVID-19 confirming the causative factor for our patient ’ s infection and e-cigarette use . 6 Although our patient was not known to be an e-cigarette user , presentation were not performed , such as sputum cultures , an extensive respiratory viral pan- he was noted to be a user of snuff , i . e . smokeless tobacco . Literature on smokeless tobacco
el , and urine antigen testing . It is also uncertain has shown that its use can trigger local , gingival if the epiglottic abscess our patient had was
vasodilatation , 7 though its role in inducing an purulent , a finding that would have supported a inflammatory response beyond oral mucosa bacterial cause for his presentation . It is possible ( and specifically involving the epiglottis ) is unclear . Importantly , smokeless tobacco use has crobiologic testing performed – that COVID-19
– and perhaps likely , given the results of the mi-
been noted to possibly increase susceptibility infection was the sole infectious cause of this to secondary infection , due to suppression of patient ’ s epiglottitis . It is also possible that this circulating levels of immune cells . 8 In the context of this particular case , this further supports our patient ’ s COVID-19 infection and epiglottitis
case involved bacterial superinfection , or that
the likelihood of our patient ’ s epiglottitis being occurred separately but simultaneously . infectious in nature , rather than being noninfectious . Another case report involved a patient
References who , similarly to our patient , also had a history of prior COVID-19 infection . The individuals 1 . Singh R , Kang A , Luo X , Jeyanathan M , Gillgrass involved in this study noted that COVID-19-in-
A , Afkhami S , Xing Z . COVID-19 : Current knowl-
4 . Devine AS , Gil MA , Counselman FL . Supraglottitis : A 39-year-old woman presented with a severe sore throat and difficulty swallowing that started after exposure to several dogs . Emergency Medicine . 2016 Oct ; 48 ( 10 ): 462-466 . https :// doi . org / 10.12788 / emed . 2016.0060
5 . Kristóf K , Pongrácz J . Interpretation of Blood Microbiology Results - Function of the Clinical Microbiologist . EJIFCC . 2016 Apr 20 ; 27 ( 2 ): 147- 55 . PMID : 27683527 ; PMCID : PMC4975230 . https :// pubmed . ncbi . nlm . nih . gov / 27683527 /
6 . Alexander Fondaw , Muzamil Arshad , Saba Batool , Brenton Robinson , Toral Patel , COVID-19 infection presenting with acute epiglottitis , Journal of Surgical Case Reports , Volume 2020 , Issue 9 , September 2020 , rjaa280 , https :// doi . org / 10.1093 / jscr / rjaa280
7 . Mavropoulos A , Aars H , Brodin P . The involvement of nervous and some inflammatory response mechanisms in the acute snuff-induced gingival hyperaemia in humans . J Clin Periodontol . 2002 Sep ; 29 ( 9 ): 855-64 . PMID : 12423300 . https :// doi . org / 10.1034 / j . 1600- 051x . 2002.290911 . x
8 . Malovichko MV , Zeller I , Krivokhizhina TV , et al . Systemic Toxicity of Smokeless Tobacco Products in Mice . Nicotine Tob Res . 2019 ; 21 ( 1 ): 101- 110 . https :// doi . org / 10.1093 / ntr / ntx230
9 . Emberey J , Velala SS , Marshal B , Hassan A , Meghjee SPL , Malik MJ , Hussain M . Acute epiglottitis due to COVID-19 infection . EJCRIM 2021 ; 8 . https :// doi . org / 10.12890 / 2021 _ 002280
118 • The Journal of the Arkansas Medical Society www . ArkMed . org