A 35-year-old-male presents to the emergency department complaining of throat swelling and difficulty swallowing. He has no past medical history and his vital signs are all within normal limits. An examination of his oropharynx follows.
What is the diagnosis?
The image shows diffuse swelling of the uvula. Uvulitis, or inflammation of the uvula, is associated with marked edema and erythema. A swollen uvula can produce a gagging sensation and patients may have difficulty swallowing their secretions. Patients may also present with fever, sore throat, and in extreme cases, respiratory distress.
Bacterial infection with Group A strep is the most common cause, almost always in associated with pharyngitis. Noninfectious causes include angioedema, acid reflux, trauma (for instance during intubation, orogastric tube placement, or suctioning), and exposure to chemical irritants.
Diagnosis is mostly clinical, however if infectious causes are suspected, appropriate cultures should be sent. Blood tests are generally unnecessary. In patients with uvulitis without pharyngitis, plain films of the neck can be ordered to evaluate the epiglottis. If patients cannot open their mouth completely or there is any concern for underlying abscess, consider CT scan with IV contrast.
Treatment is aimed at the underlying cause. In general, a single IM or IV dose of dexamethasone will help reduce swelling. For infectious cases, empiric use of antibiotics such as penicillin or macrolides is recommended. Noninfectious uvulitis is generally self-limited and will resolve spontaneously. Patients with signs of airway obstruction or distress should be admitted for observation and airway management.