Patients with isolated uvulitis often present with an erythematous, edematous, and enlarged uvula with crisp surrounding structures; it can be accompanied by fever, odynophagia, dysphagia, difficulty managing secretions, and possibly respiratory distress.³ Treatment of uvulitis typically consists of IV corticosteroids, racemic epinephrine, antihistamines, empiric antibiotics, and close airway monitoring.

This case exemplifies that uvulitis, despite its rarity, should be considered in the differential diagnosis for patients with respiratory distress or airway swelling, especially as we see a rise in the use of inhalational marijuana and other recreational drugs. Workup and treatment of isolated uvulitis should include consideration of infectious etiologies as well as inhalational etiologies. The use of nasopharyngoscopy, performed by a skilled clinician, is extremely helpful to evaluate the extend of the edema and the presence of tonsillar and laryngeal involvement.⁴

As with any airway emergency, advanced airway supplies, close airway monitoring, and temporizing agents should be used to empirically treat the patient and secure the airway. In this case, the patient’s symptoms improved with empiric antibiotics, corticosteroids, and antihistamines. However, consideration may be given to racemic epinephrine, as demonstrated in other case reports. We also advocate for an admission for close airway observation until the edema has resolved, cessation of all inhalational drug use, and close follow-up with otolaryngology.

Teaching Points

• Ask about inhalational drug use if a patient presents with isolated uvulitis.
• Broad treatment with steroids, IV antibiotics, antihistamines, and possibly racemic epinephrine should be considered until the etiology is determined.
• Use of nasopharyngoscopy is useful for excluding angioedema of vocal cords, epiglottis and larynx.

Dr. Keswani is an emergency medicine resident at the Department of Emergency Medicine at University of Virginia Health System.

Dr. Mutter is an associate professor at the Department of Emergency Medicine at University of Virginia School of Medicine.

Dr. Smith is an assistant professor at the Department of Emergency Medicine at University of Virginia School of Medicine.

References

1. Rawal SY, Tatakis DN, Tipton DA. Periodontal and oral manifestations of marijuana use. J Tenn Dent Assoc. 2012;92(2):26-31.
2. Boyce SH, Quigley MA. Uvulitis and partial upper airway obstruction following cannabis inhalation. Emerg Med (Fremantle).2002;14(1):106-108.
3. Shiber JR, Fontane E. Quincke’s Disease: isolated uvulitis. West J Emerg Med.2014;15(6):663.
4. Fappiano C, Inman BL, Bridwell RE. Isolated uvulitis in a patient after smoking fentanyl. Cureus. 2023;15(4):e38109.