key: cord-0842598-lqmz9083 authors: Chang, Kai-Ming; Epstein, Marcia E.; Kennedy, William A.; Niknam, Negin title: Supraglottitis as the sole manifestation of COVID-19 in a patient who received two doses of mRNA vaccine date: 2022-04-28 journal: J Microbiol Immunol Infect DOI: 10.1016/j.jmii.2022.04.010 sha: 1c7f5d5880ad78f1bf1235e3b1fb8b55362b6619 doc_id: 842598 cord_uid: lqmz9083 nan A 50-year-old male presented to the emergency department with fever, sore throat, and odynophagia for a day. Past medical history was significant for hypertension, diabetes (hemoglobin A1c of 8.1%), morbid obesity (body mass index of 44.7 kg/m 2 ), obstructive sleep apnea and surgical history of childhood tonsillectomy. He had received two-dose series of mRNA-1273 (Moderna) vaccine eight months prior to presentation. His temperature was elevated at 39.2 o C and the oxygen saturation was at 96% on ambient air. On physical examination, he had a non-toxic appearance and his breathing was nonlabored. Nasopharyngeal multiplex polymerase chain reaction test for respiratory pathogens was only positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bedside flexible fiberoptic laryngoscope revealed minimally edematous epiglottis, markedly edematous arytenoids and aryepiglottic folds, and mobile true vocal cords ( Figure 1A and B). Mixture of saliva and pus was observed in the supraglottis. Computed tomography (CT) neck with intravenous (IV) contrast showed a homogeneous low-density soft tissue thickening involving the supraglottis and there was thickening of the anterior and posterior commissure with narrowing of the laryngeal airway ( Figure 1C and D). The chest radiograph showed clear lung fields. The patient was started on IV dexamethasone and ampicillin/sulbactam for supraglottitis and IV remdesivir for coronavirus disease 2019 (COVID-19), both of which were discontinued at discharge. The fever and sore throat subsided within 48 hours and he was able to tolerate full solid food. Throat culture for group A Streptococcus and blood culture had no growth. He was discharged home on day 3 of admission with oral amoxicillin/clavulanate to complete a J o u r n a l P r e -p r o o f 7-day course of antibiotics to cover empirically for any possible bacterial superinfection. Telephone follow-up at one week confirmed complete resolution of symptoms. To our best knowledge, this is the first case of supraglottitis secondary to SARS-CoV-2 in a patient who completed two-dose series of mRNA vaccine. In view of the paucity of literature on epiglottitis/supraglottitis associated with COVID-19, a universal definition of such diseases cannot be established and the causative relationship is difficult to determine. However, there were ten reported cases of epiglottitis/supraglottitis related to COVID-19 (Supplementary Table S1 ). 1-10 Six of them had acute epiglottitis at the time of COVID-19 diagnosis (one required cricothyroidotomy, one required intubation, and the rest only required medical management). 1-3,5,9,10 Four cases had delayed onset of epiglottitis approximately three weeks after the initial COVID-19 diagnosis, that all required emergent airway placements. 4,6-8 These cases possibly represented bacterial superinfection on the inflamed epiglottis after COVID-19. All ten cases received antibiotics, and all but two were treated with steroids as well. There was no mortality associated with those cases. COVID-19 infection presenting with acute epiglottitis Pediatric COVID-19 presenting as supraglottitis with vocal cord hypomobility Epiglottitis Case Report: A Unique Presentation of COVID-19 Infection Acute Epiglottitis Due to COVID-19 Infection Case report: Epiglottitis in the setting of COVID-19 Acute epiglottitis after COVID-19 infection Acute epiglottitis in a COVID-19 positive patient PATIENT WITH RECENT COVID-19 INFECTION PRESENTING WITH ACUTE UPPER AIRWAY OBSTRUCTION Acute epiglottitis is a rare clinical presentation of coronavirus disease 2019: a case report COVID-19 presenting as acute epiglottitis: a case report and literature review