A Case of Acute Epiglottitis as a Presentation of Covid-19

ABSTRACT

INTRODUCTION: Acute epiglottitis is a potentially fatal condition due to high risk of respiratory failure from upper airway obstruction and resultant difficulty securing a patent airway. The etiology is most commonly infectious although noninfectious etiologies have been identified. We present a rare case of acute epiglottitis as a presentation of COVID-19. DESCRIPTION A 37-year-old male with a past medical history of health presented due to acute throat pain with difficulty swallowing, and without dyspnea or cough. The patient took no medications or supplements, had no known sick contacts, chemical inhalation, recent travel, or any known allergies. He had never received vaccination for COVID-19. He occasionally smoked cigarettes and marijuana, and did not consume alcohol or use illicits. The patient was febrile and had a swollen, tender submandibular area and tender cervical lymphadenopathy. Solids, liquids, and saliva were difficult to swallow but he was in no respiratory distress. A CT of the neck showed the classic "thumb sign" of a thickened epiglottis as well as thickening of the laryngeal soft tissues. Visualized by flexible laryngoscopy, the epiglottis was erythematous and severely swollen;vocal cords functioned normally. He had neutrophilic predominant leukocytosis with monocytosis. A nasopharyngeal swab PCR was positive for SARS-CoV-2, however a broad work up for other viral and bacterial pathogens was negative. He was admitted to the intensive care unit and treated with broad spectrum antibiotics and high dose corticosteroids. After five days of monitoring, no intubation or airway intervention was needed. He improved as he tolerated a liquid diet and was discharged home with antibiotics. DISCUSSION: 18 cases of acute epiglottitis associated with COVID-19 have been reported, and the incidence is likely underestimated. The mechanism of epiglottitis in SARSCoV- 2 infection is poorly understood;whether directly caused by the virus versus by Increased susceptibility to bacterial superinfection. Clinicians should be aware of this condition due to the high risk of airway compromise and mortality without prompt diagnosis and appropriate management. Early involvement of skilled providers is critical as patients may require nasotracheal intubation, tracheostomy, or emergent cricothyrotomy.