The pale epiglottitis--a misnomer or not?

Several leading authors on acute epiglottitis have reported a pale appearance of the swelling of the epiglottis in otherwise seemingly classical cases of acute epiglottitis. In order to understand this phenomenon better, a thorough review of the literature was done but only scarce comments were gathered. There seems to be a spectrum of appearance of the epiglottis in acute epiglottitis, the erythema as well as the edema varying independently from mild to marked. A striking feature of this type of epiglottitis is that, despite seemingly appropriate treatment, a most treacherous evolution was reported: four out of 12 cases presented a severe sudden apnea and two others developed an abscess. Aggressive antibiotherapy and steroidotherapy are suggested as well as a prophylactic nasotracheal intubation.