Recurrent acute epiglottitis in adults: defective antibody response.

BACKGROUND

Recurrent acute epiglottitis is uncommon in adults. In the medical literature, very little is known about the immune status of this population.

OBJECTIVE

To evaluate the immune system of a group of four adult patients with recurrent acute epiglottitis, in what represents the largest series ever reported.

METHODS

The clinical course of these episodes was carefully evaluated and a basic immune deficiency work-up was carried out for each patient.

RESULTS

All four patients displayed clinical and laboratory evidence of impaired humoral immunity. One patient was splenectomized. Another patient had a below normal immunoglobulin G level. At the time of their first evaluation, none of our patients had specific antibodies against Haemophilus influenzae and one had a subnormal Streptococcus pneumoniae immunoglobulin G level for a majority of serotypes. After specific vaccination, two patients had persistent abnormalities in their response to one or more polysaccharides or conjugate-polysaccharide antigens. In the other two, the transient abnormalities were corrected by immunization.

CONCLUSIONS

When recurrent acute epiglottitis occurs in adults, it is important to investigate the immune system because a quantitative or a specific antibody deficiency could be found. It also follows that these patients will be successfully treated either by immunization or antibody replacement.