Delayed Diagnosis of an Adult Epiglottic Abscess: A Case Report

Distinguishing acute epiglottitis from other benign causes of sore throat can be challenging in the adult age group, and failure to do so can lead to an airway-related death. We report the case of a 65-year-old man with type 2 diabetes who initially presented with sore throat, odynophagia, and fever, and was twice discharged with presumed pharyngitis after outpatient and emergency department evaluations. Within 24 hours, he returned with worsening odynophagia and inability to swallow medications. Despite stable vital signs and absence of stridor and drooling, laboratory testing revealed leukocytosis and markedly elevated inflammatory markers. Lateral neck radiography demonstrated the thumbprint sign, and computed tomography confirmed a 28×24×18 mm periepiglottic abscess. Flexible laryngoscopy revealed severe hypopharyngeal swelling with an epiglottic abscess. He underwent controlled awake fiberoptic intubation followed by surgical drainage, intravenous antibiotics, corticosteroids, and supportive care, with full recovery and discharge after four days. This case highlights that persistent sore throat and odynophagia refractory to initial therapy should raise suspicion for epiglottitis or an epiglottic abscess, even in well-appearing adults. Early imaging, mobilization of airway experts, and proactive airway planning are critical for preventing catastrophic airway loss.