Severe croup in children infected with SARS-COV-2

Abstract

ABSTRACT Croup (laryngotracheitis) is frequently encountered in the emergency department among young children presenting with stridor. We described two previous healthy children who were admitted to our emergency department (ED) as the first documented cases of severe croup as a manifestation of SARS-CoV-2 infection in our hospital. Both cases (9 months and 8 months) 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 antigen Rapid test from nasopharyngeal samples. Each received multiple doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. Both were admitted and received several doses of dexamethasone, which is an atypical treatment in our hospital due to the prolonged duration of symptoms in each patient. Antibiotics were used for both cases. 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 due to 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.