Supplementary Material for: Epiglottitis in Patients Treated for Acute Leukemia – Case Series and Systematic Review of the Literature

Acute epiglottitis is a medical emergency characterized by inflammation of supraglottic structures of the larynx and epiglottis. The clinical characteristics and course of this complication in acute leukemia (AL) is largely unknown. We present a case-series and a systematic review of the literature of adult patients with AL and acute epiglottitis.
Four patients with acute myeloid leukemia (age 38-61 years) were diagnosed with acute epiglottitis during their intensive treatment course. One patient presented with epiglottitis at the end of induction, two at the end of consolidation therapy and one patient presented with a later event. Three patients were in grade 4 neutropenia during infection onset (median aplasia duration to event nine [range 4-14] days). All patients presented with neck pain and dysphagia and two patients also had dyspnoea at presentation. Urgent invasive airway protection was required in three patients. Two patients died due to this complication, one suffered anoxic brain injury. A systematic literature review identified 8 additional cases of epiglottitis.
Acute epiglottis is a rare but significant medical emergency with unique challenges in the setting of AL that is caused by atypical infectious pathogens. Early detection and a multidisciplinary therapeutic effort are crucial to improve patient outcome.