We describe a 36-year-old man with chronic lymphocytic leukemia diagnosed with acute epiglottitis by direct laryngoscopy. Blood cultures grew Pasteurella multocida. The patient's only identifiable risk factor was transient contact with a healthy neighborhood cat; no bites or scratches were sustained. The patient was successfully treated with penicillin. We conducted a PubMed and Ovid literature search on P. multocida epiglottitis and found a total of 6 cases. Common features included lack of immunosuppression, nonbite exposures, diagnosis through blood cultures as opposed to direct epiglottic culture, and cure with intravenous and oral antibiotics. Our patient had similar characteristics to the reported cases except for the fact that he was relatively immunosuppressed. Although the existing case reports in the literature highlight infection in healthy individuals, our case demonstrates that clinicians must consider P. multocida as a possible etiology of acute epiglottitis in immunosuppressed individuals who have even trivial exposure to cats.
From the Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX.
Reprints: Vidhya Prakash, MD, Infectious Disease Service, San Antonio Military Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234. E-mail: firstname.lastname@example.org.