Screening immigrants at risk of tuberculosis

disease must be considered.I became aware of an association between adult epiglottitis and malignancy when treating a patient with acute epiglottitis due to infection with Branhamela catarralis who was subsequently diagnosed as having acute myeloid leukaemia.'There have been other reports of acute epiglottitis in patients with leukaemia,3 and Lederman et al described seven cases of pneumococcal epiglottitis, six of which were associated with some form ofmalignancy.4Thus an underlying malignancy or other inmmunosuppressive disease5 should be suspected in cases of adult epiglottitis.This association may simply represent opportunistic infection occurring in immunocompromised patients and need not indicate a specific link.Assessment of the whole patient is, however, vitally important, even when the presenting symptoms and signs seem to be localised.