Pediatric croup with COVID-19

Abstract

We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient's prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with “COVID-19 croup,” SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.

Pediatric COVID-19 presenting as supraglottitis with vocal cord hypomobility

“…3 This is one of the first few reports of COVID-19 cases with this presentation and adds to the growing body of literature on upper airway manifestations of COVID-19. 4,5 The case A 15-year-old female presented to the emergency room in mid-April 2020, with a 2-day history of worsening cephalalgia, hoarseness and muffling of voice, difficulty swallowing and globus pharyngeus. She had nausea and generalized malaise with the above symptoms.…”

“… 3 This is one of the first few reports of COVID-19 cases with this presentation and adds to the growing body of literature on upper airway manifestations of COVID-19. 4 , 5 …”

Croup: A Rare Manifestation of Coronavirus Disease 2019

“…2 The diagnosis of croup is mostly clinical and determining the etiology is rarely helpful. 3,4 Usually, viral croup is a self-limiting illness that typically resolves within 3 to 7 days in most cases. 4 Our baby presented with classical clinical features of croup and neck X-ray showed steeple sign.…”

S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19

“…Nach [173]. Zusätzlich wurde eine Fallserie von Kindern mit COVID-19-assoziierten akuten Krupp-Anfällen publiziert [174]. Bisher wurden bei Säuglingen und Kindern nur Einzelfallberichte über die bei Erwachsenen häufig auftretende COVID-19-Pneumonie oder ein akutes Lungenversagen berichtet [175,176].…”