Acute Bacterial Epiglottitis and COVID-induced Angioedema of the Larynx Are Possible Differential Diagnoses

Abstract

To the Editor We read the article, "A Case of COVID-19 Presenting with Acute Epiglottitis," published by Yamada A et al. in Internal Medicine Advance Publication 0163-22 (1) with great interest. The authors carefully assessed, treated, and described this potentially life-threatening illness that can lead to complete upper airway obstruction. However, we have two major concerns about their conclusion due to a lack of details. Therefore, we would like to know the details with regard to this patient's clinical course.Epiglottitis is associated with various pathogens, including bacteria, viruses, and fungi (2). We suspected that the patient had superinfection with bacteria pathogen based on the neutrophil-dominant inflammatory reaction and susceptibility to antibiotics. Although the authors seem to interpret this case as a rare case of acute epiglottitis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, acute bacterial epiglottitis should also be considered, as COVID-19 is often asymptomatic in young people without complications, such as hypertension and diabetes mellitus (3). Our first concern that we would like the authors to address is whether or not the patient had evidence of any other respiratory viruses or bacterial organism infections, such as Influenza A, Influenza B, or Haemophilus influenzae. The reply to this point is very critical in order to clarify whether or not SARS-CoV-2 can cause acute epiglottitis and to help establish a treatment modality for acute epiglottitis caused by SARS-CoV-2 infection. Treatment with corticosteroids, antibiotics, and epinephrine inhalation, which the authors performed on this patient, is also effective for acute bacterial epiglottitis. Furthermore, if the diagnosis of this