CASE Cover REPORT Story
Acute Epiglottitis as a Possible Manifestation of COVID-19 Infection
Abstract
We describe the case of a man who presented from an urgent care center for evaluation after being diagnosed with acute epiglottitis . The patient maintained a patent airway and was discharged after several days of conservative treatment . He tested negative for Strep A and Mononucleosis and positive for SARS- CoV-2 infection . Blood cultures showed presence of gram-positive cocci in clusters in one of three bottles , though Staphylococcus aureus was not detected . With this result likely being a clinically insignificant contaminant , and without any other positive microbiologic or noninfectious findings , it could be presumed that this patient ’ s epiglottitis was secondary to COVID-19 . by Syed Umar Suhail , OMS-IV ; 1 Stacy Richardson , DO ; 2 Andrea Duchow , DO 3
1
NYIT College of Osteopathic Medicine at Arkansas State University , Jonesboro , Ark
2
Department of Emergency Medicine , NEA Baptist Memorial Hospital , Jonesboro , Ark
3
Department of Internal Medicine , NEA Baptist Memorial Hospital , Jonesboro , Ark
Background
SARS-CoV-2 ( otherwise known as the novel coronavirus or COVID-19 ) has been known since its discovery to present in different forms and to various extents . As it is classified as a severe acute respiratory syndrome , COVID-19 infection predominantly causes respiratory tract symptoms . However , literature has progressively identified that the manifestation of COVID-19 can be non-specific , ranging anywhere from an asymptomatic presentation to acute respiratory distress syndrome leading to multiple organ dysfunction . 1
Case Presentation
A young-adult , obese Caucasian male with a surgical history of tonsillectomy , social history positive for snuff use , and otherwise no pertinent comorbidities or allergies , presented to an urgent care facility with a one-day history of left-sided sore throat , fever , hoarseness , dysphagia , and odynophagia . The patient reported experienc-
Figure 1 . Image displaying AP and transverse dimensional measurements of epiglottic enlargement .
ing no relief with acetaminophen or ibuprofen . leukocytosis ( 25.1 x 10 9 / L ). A CT Soft Tissue Neck He denied significant dyspnea or sialorrhea . On with Contrast was later ordered , which showed exam , the patient had posterior oropharyngeal marked enlargement of the epiglottis secondary erythema , as well as superficial bilateral cervical to an abscess located anteriorly in the region of adenopathy . Vital signs were remarkable for lowgrade fever ( temperature of 38.1 o C ) and tachy- the frenulum . Upon discovery of this radiologic finding ,
cardia ( 108 beats per minute ). The rest of his the patient was sent to the emergency department . Blood cultures were collected , as well physical exam was unremarkable . He was alert , his lungs were clear to auscultation bilaterally , as a procalcitonin level , which was found to and he had normal respiratory effort . There was be mildly elevated ( 0.33 ng / mL ). A manual differential later collected showed a segmented no evidence of stridor or trismus on exam .
A series of laboratory tests were ordered neutrophil percentage of 76 %. Aside from mild during the patient ’ s stay at the urgent care facility . Strep A and Mononucleosis screening tests within normal range . He received IV dexametha-
hyponatremia , the basic metabolic panel was
were negative . However , a SARS-CoV-2 screening sone 10 mg while in the emergency department , test was positive . This was the patient ’ s second and after blood culture collection , was started positive test for COVID-19 , as he reported testing on IVPB clindamycin 900 mg / 50 mL . ENT was positive around four months prior to current visit . The patient was also found to have significant with scheduled steroid therapy and
consulted and recommended ICU admission , continuous
116 • The Journal of the Arkansas Medical Society www . ArkMed . org