Abstract / Summary
Epiglottic abscess is a rare but potentially life-threatening complication of adult epiglottitis that can rapidly progress to upper airway obstruction.Although surgical drainage has traditionally been recommended, the optimal management of clinically stable patients remains uncertain.We report a case of a 55-year-old female with no significant medical or surgical history who presented with a three-day history of progressive dysphagia, odynophagia, muffled voice, reduced oral intake, and mild left-sided neck swelling.She was clinically stable, with no stridor, dyspnea, drooling, or hypoxia.Flexible fiberoptic laryngoscopy demonstrated marked supraglottic edema with preserved bilateral vocal cord mobility and an adequate glottic airway.Laboratory investigations showed marked leukocytosis and inflammation (WBC: 20 × 10⁹/L; CRP: 212 mg/L), while contrast-enhanced computed tomography revealed a rim-enhancing epiglottic collection extending to the floor of the mouth, consistent with an epiglottic abscess.The patient was admitted to the intensive care unit and treated conservatively with intravenous ceftriaxone, clindamycin, dexamethasone, and close airway monitoring, with surgical drainage and airway intervention reserved for clinical deterioration.Within 48 hours, she showed marked clinical improvement, normalization of the leukocyte count, a reduction in CRP, and improvement in supraglottic edema on repeat laryngoscopy.Surgical intervention was not required, and she was discharged on oral antibiotics with complete resolution of symptoms.This case highlights that conservative management may be successful in carefully selected adults with epiglottic abscess, particularly when the airway remains stable and there is an early clinical response to treatment.However, given the potential for rapid deterioration, conservative management requires close airway monitoring, serial reassessment, and immediate access to surgical drainage and definitive airway intervention.