key: cord-0924014-ertiqtnw
authors: Alhedaithy, Alhanouf A.; Aldabal, Nada
title: Acute laryngotracheitis caused by COVID-19: A case report and literature review
date: 2022-04-12
journal: Int J Surg Case Rep
DOI: 10.1016/j.ijscr.2022.107074
sha: be250c96abd089e1b469d1012a3298c1f5f87f5b
doc_id: 924014
cord_uid: ertiqtnw

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laryngotracheitis (croup) is rare manifestation of COVID-19 in adults. PRESENTATION OF CASE: A 52-year-old female presented to the emergency department with shortness of breath and inspiratory stridor. CLINICAL FINDINGS AND INVESTIGATIONS: Physical examination of the head and neck revealed a congested posterior pharyngeal wall. Laryngeal endoscopy with a 70-degree rigid endoscope demonstrated an edematous, bilaterally moving vocal cords. Chest radiographs showed tapering of the upper trachea (the “steeple” sign), which is observed in parainfluenza-associated croup infections. INTERVENTIONS AND OUTCOME: The patient was admitted to the ICU for close observation for possible airway compromise and the need for intubation. Upon which, she tested positive for COVID-19 by polymerase chain reaction testing of nasopharyngeal samples. A regimen of ceftriaxone, nebulized racemic epinephrine, and dexamethasone was initiated. CONCLUSION: During the current COVID-19 pandemic, early diagnostic testing for SARS-Cov-2 are strongly recommended even when symptoms are not typical of COVID-19.

The patient was a 52-year-old female nonsmoker with a history of hypertension (controlled with amlodipine, 10 mg once daily), type 2 diabetes mellitus (controlled with metformin, 500 mg thrice daily, and linagliptin, 5 mg once daily), dyslipidemia (controlled with atorvastatin, 10 mg once daily), and Sheehan syndrome (controlled with levothyroxine, 100 mcg once daily, and hydrocortisone, 10 mg once daily). She presented to the emergency During physical examination, the patient exhibited inspiratory stridor; a nasal cannula was placed, and 2 L of oxygen was administered. Throat examination revealed congestion in the posterior pharyngeal wall. Laryngeal endoscopy with a 70-degree rigid endoscope revealed edematous, bilaterally moving vocal cords. Chest radiographs showed tapering of the upper trachea (the "steeple" sign), which is observed in parainfluenza-associated croup infections (Fig.   1 ). The complete blood cell count was normal, the C-reactive protein level was 108 mg/L, and her arterial blood gas measurements included a pH of 7.36, a base deficit of −4.6 mmol/L, and a partial pressure of oxygen of 54.2 mm Hg. She was then transferred to the ICU for close observation for possible airway compromise and the need for intubation. Upon her admission Figure 1 

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