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Clinical Challenge
September 3, 2020

Progressive Upper Airway Obstruction and Dysphagia in a Child With Supraglottic Edema

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, St Louis University Hospital, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. Published online September 3, 2020. doi:10.1001/jamaoto.2020.2577

A 9-year-old, vaccinated boy with glucose-6-phosphate dehydrogenase deficiency and β-thalassemia trait presented with 1 month of progressive dyspnea, snoring, dysphagia, and weight loss. Both parents had a history of latent tuberculosis infection treated after immigrating to the US from Syria shortly after the patient’s birth. The patient’s pediatrician diagnosed him with reactive airway disease and adenotonsillar hypertrophy. He was referred to the otolaryngology clinic, where flexible laryngoscopy revealed diffuse upper airway lymphoid hyperplasia and supraglottic edema. He was sent to the emergency department, where he was stridulous and afebrile with a normal white blood cell count and an elevated erythrocyte sedimentation rate. A computed tomography scan of the neck revealed diffuse edema and contrast enhancement of the nasopharynx, oropharynx, hypopharynx, and supraglottis. A chest radiograph was normal.

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