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Clinical Challenge
December 2016

Endoscopy Dyspnea and Ulcerative Colitis

Author Affiliations
  • 1Department of Ear, Nose, and Throat, General Hospital “G. Gennimatas,” Thessaloniki, Greece
JAMA Otolaryngol Head Neck Surg. 2016;142(12):1243-1244. doi:10.1001/jamaoto.2016.1764

A woman in her 20s presented to the emergency department with a 2-week history of progressive sore throat, dysphagia, and fever (38.2°C) that developed into dyspnea, dysphonia, and neck pain on the day of presentation. Initially, she had been treated with oral amoxicillin–clavulanic acid with no improvement. Her medical history included ulcerative colitis (UC) controlled by oral azathioprine for 2 years. She was a nonsmoker. Initial clinical evaluation revealed respiratory distress with respiratory rate of 21 breaths per minute, with oxygen saturation 95% on room air. Her heart rate was 95 beats per minute, her blood pressure was 135/91 mm Hg, and she was pyretic. Further examination with flexible fiberoptic laryngoscopy (Figure, A) showed considerable erythema and edema of the epiglottitis with patchy necrosis partially obstructing the glottis and saliva pooling in the supraglottis. Findings from the remainder of the otolaryngology examination and chest auscultation were normal. Subsequently, oxygen saturation improved to 100% with 3 L per minute of oxygen via nasal prongs. Her initial laboratory findings revealed a white blood cell count of 12 000/μL, absolute neutrophil count of 46%, hemoglobin count of 12.8 g/dL, and a platelet count of 175 000/μL. Her C-reactive protein level was 5 mg/dL (normal level, <0.5 mg/dL). Results from liver function tests and chest radiograph were normal.

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