Thermal epiglottitis in adults: a new complication of illicit drug use.

Four cases of acute epiglottitis due to thermal injury were identified in a larger study of 407 cases of epiglottitis in Rhode Island from 1975 through 1992. All occurred in young adults (aged 22-33 yr) and were caused by the inhalation of heated objects when smoking illicit drugs (a tip of a marijuana cigarette in 1 case and metal pieces from crack cocaine pipes in 3 cases). Symptoms, signs, and X-ray and laryngoscopic findings were similar to infectious epiglottitis. All recovered with observation and intravenous antibiotics; none required intubation. Emergency physicians should be aware of this etiology when managing young adults who present with acute epiglottitis.