Delayed-Onset Post-extubation Laryngeal Edema Complicated by Epiglottitis: A Case Report

Post-extubation laryngeal edema (PELE) is a well-documented complication of endotracheal intubation, typically presenting within hours of extubation. PELE, following elective procedures, is usually mild and resolves with conservative management. We report the case of a 73-year-old male patient who developed progressive odynophagia and dysphagia 24 hours after an uneventful inguinal hernia repair under general anesthesia. A contrast-enhanced CT scan of the neck revealed laryngeal edema extending to the epiglottis, raising concern for epiglottitis. Flexible fiberoptic laryngoscopy confirmed moderate edema involving the arytenoids and epiglottis, with preservation of airway patency. The patient was treated empirically with corticosteroids and broad-spectrum antibiotics due to concern for a possible infectious process, and subsequently made a full recovery without recurrence of symptoms. This case illustrates an unusual presentation of delayed-onset PELE coexisting with epiglottitis in the absence of a confirmed infectious etiology. It underscores the importance of early recognition and careful airway monitoring in patients with evolving post-extubation symptoms. While corticosteroids are effective in reducing PELE incidence, their role in treating epiglottitis remains debated due to inconsistent evidence regarding benefits and potential risks. Further investigation is necessary to clarify the association between endotracheal intubation and the development of epiglottitis, and to inform evidence-based approaches for managing cases where PELE and supraglottic infection overlap.