Tonsillar hypertrophy and prolapse in a child – is epiglottitis a predisposing factor for sudden unexpected death?
Date
2020-01-20
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils
include haemorrhage, retropharyngeal abscess and disseminated sepsis.
Case presentation: We report on a case of sudden and unexpected death in an 8-year-old female who was
diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse
and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was
found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning
after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled
the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of
the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal
swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but
no evidence of acute inflammation.
Conclusion: Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and
has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the
theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils
may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the
enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role
in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This
focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a
thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy.
Description
CITATION: Nieuwoudt, I., et al. 2020. Tonsillar hypertrophy and prolapse in a child – is epiglottitis a predisposing factor for sudden unexpected death?. BMC Pediatrics, 20:22, doi:10.1186/s12887-020-1927-3.
The original publication is available at https://bmcpediatr.biomedcentral.com
The original publication is available at https://bmcpediatr.biomedcentral.com
Keywords
Tonsillitis -- Risk factors, Tonsillar hypertrophy -- Risk factors, Epiglottis -- Infections, Children -- Mortality
Citation
Nieuwoudt, I., et al. 2020. Tonsillar hypertrophy and prolapse in a child – is epiglottitis a predisposing factor for sudden unexpected death?. BMC Pediatrics, 20:22, doi:10.1186/s12887-020-1927-3