A 30-year-old male patient complains of fever and sore throat for several days. The patient
presents to you today with additional complaints of hoarseness, difficulty breathing, and
drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the
following is the best course of action?
a. Begin outpatient treatment with ampicillin
b. Culture throat for β-hemolytic streptococci
c. Admit to intensive care unit and obtain otolaryngology consultation
d. Schedule for chest x-ray
Answer and explanation
The answer is c.
This patient, with the development of hoarseness, breathing difficulty, and stridor,
is likely to have acute epiglottitis. Because of the possibility of impending airway
obstruction, the patient should be admitted to an intensive care unit for
close monitoring. The diagnosis can be confirmed by indirect laryngoscopy
or soft tissue x-rays of the neck, which may show an enlarged epiglottis.
Otolaryngology consult should be obtained. The most likely organism
causing this infection is Haemophilus influenzae. Many of these organisms
are β-lactamase-producing and would be resistant to ampicillin. The clinical
findings are not consistent with the presentation of streptococcal pharyngitis.
Lateral neck films would be more useful than a chest x-ray.
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