A Curious Case of Croup: Laryngotracheitis Caused by COVID-1
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In early May 2020, a term, unvaccinated 14-month-old boy who was recently diagnosed with influenza A in February presented with 2 days of fever, cough, and stridor. His maximum temperature was 38°C at home. Cough and stridor were intermittent, with increased work of breathing only when crying.

The patient presented for difficulty in breathing. He arrived with a fever of 39.3°C, which resolved with acetaminophen. He was initially tachycardic to 194 beats per minute & BP was 103/85 mm Hg, respiratory rate was 40 breaths per minute, and he was saturating 100% on room air. Physical examination findings were significant for tachypnea, nasal flaring, and inspiratory stridor.

The patient was found to be positive for COVID-19 via point-of-care testing. A respiratory pathogen nucleic acid amplification panel (which was not used to test for COVID-19) was negative for other viral etiologies. The CRP level was 34 mg/dL.

Because of early concern for epiglottitis given the patient’s unvaccinated status, neck and chest radiographs were obtained, which revealed subglottic narrowing. After initial treatment with racemic epinephrine and dexamethasone he arrived stable on room air, with mild inspiratory stridor only when crying, and was tolerating oral hydration. Patient had an uneventful hospitalization and was discharged from the hospital the following day with supportive care and outpatient follow-up.

This case indicates that SARS-CoV-2 can cause croup in pediatric patients. This presentation of disease is not unprecedented because other coronaviruses have previously been shown to cause croup. However, SARS-CoV-2 causes a broad spectrum of diseases, ranging from asymptomatic infection to acute respiratory failure, as well as the emerging MIS-C causing Kawasaki-like disease with shock requiring ICU admission. SARS-CoV-2 has thus been shown to cause a wide array of clinical presentations and severity of disease.

This case represents a new presentation of COVID-19 in pediatric patients. Researchers recommend that infants and children presenting with symptoms concerning for croup be tested for COVID-19 so that appropriate isolation precautions can be taken to limit disease transmission.

Source: https://pediatrics.aappublications.org/content/early/2020/12/15/peds.2020-012179?rss=1
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