Question 286

Question:

A 5 year old boy is brought into the emergency department late in the evening by his mother who reports that her child is having difficulty breathing. The mother believes that the child swallowed a small toy he was playing with before bed and insists the boy was completely normal before being put to bed earlier that night. Physical exam reveals a child in respiratory distress, sitting upright and forward with audible inspiratory stridor. Inspection of the oropharynx is clear. In addition, the child is febrile to 102.5ºF and is drooling from the mouth. What is the most likely etiology?

Correct Answer: B.  H. influenza acute epiglottitis

H. influenza (choice B) can cause multiple conditions including acute epiglottitis, meningitis, otitis media, and pneumonia. In the setting of a fever, inspiratory stridor, and drooling from the mouth, the diagnosis of acute inflammation of the epiglottis causing obstruction of the airway needs to be recognized. Lateral X-rays of the neck can be used to be confirm the clinical diagnosis.

Foreign body obstructing the airway (choice A) would not explain the high fever that the child is experiencing.

Compromised airway from child abuse (choice C) is not likely in the setting of a fever. Additionally, bruising patterns on the child’s neck suggesting choking were not described on physical exam.

RSV (choice D) is not a known cause of epiglottitis; however, it can cause respiratory tract infections (bronchiolitis, pneumonia) in children and infants.

Streptococcus (choice E) does not commonly cause epiglottitis but is more commonly the cause of exudative pharyngitis which was not described on physical exam.