ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laryngotracheitis (croup) is a rare manifestation of COVID-19 in adults. Presentation of case: A 52-year-old female presented to the emergency department (ED) 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 intensive care unit (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.