REPORT OF A CASE OF ACUTE EPIGLOTTITIS WITH HEMATOMA FORMATION IN THE EPIGLOTTIS

Abstract

　Herein, we report a case of acute epiglottitis with formation of a hematoma in the epiglottis, with the risk of further worsening of the patient's condition. The patient was a 51-year-old male who visited our otolaryngology department with a history of experiencing an unpleasant sensation in the throat and difficulty in swallowing water since the previous day. He had undergone artificial valve replacement for aortic stenosis at our hospital, and was taking warfarin potassium 5 mg and aspirin 100 mg daily. Endoscopic examination revealed notable swelling at the base of the tongue, along with an epiglottic hematoma. We measured the PT-INR for evaluation of the clotting function. Since the value was abnormally high (over 12), we immediately consulted the cardiac surgery department. We started the patient on a steroid and antibiotic and administered 60 mg of menatetrenone to the patient as an urgent intervention, and the PT-INR level returned to within the normal range (1.4). We continued to administer the antibiotic and steroid and took a conservative wait-and-watch approach. The patient gradually recovered and was eventually discharged from the hospital. In patients on routine anticoagulant therapy presenting with acute epiglottitis, it is important to be alert to the risk of a hematoma and the patient's condition becoming worse. In addition, in such patients, tracheotomy may be risky as it would be potentially difficult to control the amount of bleeding; therefore, it is essential to consult with the department that prescribed the anticoagulant and decide carefully on the further course of treatment.