Supraglottitis Due to Herpes Simplex Virus Type 1 in an Adult

We describe a case of HSV-1 supraglottitis in an adult. A 31-year-old woman was brought to the emergency department because of "bizarre behavior" that had started that morning. She was found hitting the wall, shouting at her family, and attempting to run out of her house. A CT scan of the neck showed marked edema with a soft-tissue mass surrounding and encasing the airway and pharynx. The patient was treated for acute supraglottitis with ceftriaxone and clindamycin. On hospital day 9 she underwent direct laryngoscopic examination and tracheostomy, as she had remained intubated with no improvement in her condition. The examination showed marked pharyngeal and supraglottic edema. A smooth polypoid mass measuring 2.5 cm x 2 cm was seen and biopsied. Cells that had opaque nuclei with margination of the chromatin and multinucleated giant cells (findings consistent with herpes virus infection) were seen. Viral cultures were positive for HSV-1. Bacterial cultures yielded methicillin-resistant Staphylococcus aureus. Therapy with acyclovir was started. Vancomycin therapy for a possible superimposed infection was also begun. She completed a 21-day course of acyclovir therapy and was successfully decannulated.