Ruminations on idiotitis.


Probably one of my favorite structures in the human body is the uvula. Maybe it comes from my childhood love of stalactites (nerd alert!), but there's something endearing about that little ball of mucosa hanging suspended from the back of your throat.

Little, that is, until it gets infected.

In one of the more bizarre medical presentations I have ever been around, a patient came in 3 days after having his uvula pierced. That's right, he pierced his uvula. Even more amazing, this sort of thing actually came up with a google image search.

Exhibit A:

On examination, his uvula had swollen nearly to the size of a golf ball and was at risk of closing off his airway. And stuck in the middle of it, like a hula hoop around John Daly, was his newly acquired uvula bling.

We checked his epiglottis, and that seemed to be golden, so he wasn't at immediate risk of asphyxiation and this was almost certainly a case of a non-sterile piercing. The #1 etiology of bacterial uvulitis is group A strep, but since this was due to direct trauma by an instrument we weren't sure what it was, so we took a culture and put him on some amoxicillin and told him to follow up in 3 days. But as a parting gift, the PCP also gave him an epi pen and told him to inject his uvula if he felt like he could no longer breathe, and that should buy him time to get to an ED.

Yup. If he felt like he couldn't breathe, and was panicking, he was supposed to take this pen, put it him his mouth, and inject the back of his throat. His eyes got pretty big as the doc told him that one. If he was looking for a little "badass factor" with his new throat ornament, I think he got a little more than he bargained for. But hey, every guy on a certain level has to wish he could do his own little personal re-enactment of the scene in The Rock where Nicholas Cage injects himself to save his life. I should have given him some green flares for dramatic effect.