(495) From Dog Scratch to Epiglottitis

Introduction: Epiglottitis is a life-threatening inflammation of the epiglottis that can obstruct the airway. Incidence in adults ranges from 0.87 to 3.1 per 100,000 with mortality of 7.1% (1). The most common cause is Haemophilus influenzae type B, which has decreased after vaccinations. Other culprits are Staphylococcus Aureus, Streptococcus Pneumoniae and Streptococcus pyogenes. Pasteurella Multocida, a gram-negative coccobacillus found in dogs and cats, is an infrequent cause. We present the case of an immunocompetent patient who was in close proximity to a dog and suffered an extensive febrile course of Pasteurella epiglottitis.

Description: 68-year-old male with atrial fibrillation and hypertension presented with fever and sore throat of 2 days duration with a temperature of 102.8 °F. He endorsed a hoarse voice and inability to swallow. On physical exam, there was notable neck swelling, a small abrasion on the right lateral neck, left posterior cervical lymphadenopathy and stridor. He became hypotensive, requiring vasopressors and emergent intubation. Findings were significant for WBC 26,700 and creatinine 1.53. Contrast enhanced computed tomography of the neck showed symmetric mucosal edema of the supraglottic larynx and oropharynx, thickening of the epiglottis and narrowing of airway. Broad-spectrum antibiotics and parenteral glucocorticoids were administered. On day two, blood cultures yielded Pasteurella multocida. Upon further questioning, his wife shared that they own a small dog that often sleeps near the patient’s head, explaining that the abrasion on his neck was a dog scratch. The patient had a lengthy ICU course, marked by intermittent fevers and difficulty weaning from mechanical ventilation. Subsequent CT imaging revealed minimal improvement in oropharyngeal swelling. After a slow progression he was successfully liberated from the ventilator after ten days of mechanical ventilation. He was ultimately discharged home and made a full recovery.

Discussion: Pasteurella species have been the most widespread isolates from bites of dogs and cats. In our patient, it is suspected that the dog transferred Pasteurella multocida via scratching or respiratory droplets. Pasteurella epiglottitis is a rare manifestation of infection and prompt diagnosis and treatment is of utmost importance.