COVID-19 presenting as acute epiglottitis: A case report and literature review

• Published in: Auris, nasus, larynx Vol. 50; no. 1; pp. 165 - 168
• Main Authors: Iwamoto, Shusuke, Sato, Mitsuo P., Hoshi, Yujiro, Otsuki, Naoki, Doi, Katsumi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2023; Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V
• Subjects: Acute Disease; Acute epiglottitis; Adult; Case Report; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 Testing; Epiglottitis - diagnosis; Epiglottitis - drug therapy; Humans; Laryngitis - diagnosis; Male; Pneumonia; Tuberculous laryngitis; COVID-19; Pneumonia; Acute epiglottitis; Tuberculous laryngitis
• ISSN: 0385-8146; 1879-1476
• DOI: 10.1016/j.anl.2021.12.007

Coronavirus disease 2019 (COVID-19) occasionally causes acute laryngitis, requiring emergency treatment. Understanding the characteristic laryngeal findings can help diagnose COVID-19 earlier, prevent worsening infection, and properly manage airway obstruction. Herein, we report the case of a 44-year-old male with acute epiglottitis likely caused by COVID-19. On presentation, chest computed tomography (CT) showed no signs of pneumonia. However, the larynx had extensive necrotic-like erosive lesions resembling those of tuberculous laryngitis. COVID-19 was diagnosed by reverse-transcription polymerase chain reaction, and secondary bacterial superinfections were suspected after blood testing. The symptoms improved after administration of antibiotics (sulbactam sodium/ampicillin sodium), steroids (dexamethasone), and favipiravir. The patient developed a high fever on the sixth day of hospitalization, and pneumonia was identified on CT. Various culture tests, including tuberculosis, were negative. Thus, remdesivir was administered for COVID-19-induced pneumonia. The patient gradually recovered, was transferred to another hospital, and was discharged on the 35th day of hospitalization. Six previous case reports of COVID-19-induced acute epiglottitis suggested that acute epiglottitis preceded the onset of pneumonia. The laryngeal findings from this report may be useful for diagnosing COVID-19 that does not cause pneumonia and for bringing attention to pneumonia after a COVID-19 diagnosis.