Document Type : case report


1 Professor, Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 1Assistant professor, pediatric pulmonologist Affiliation:1-Hematology and Oncology Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran. 2Children Growth Disorder Research Center, Shahid Sadoughi University

3 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Otorhinolaryngology, Shahid Sadoughi Hospital, Yazd, Iran. Sayad Shirazi Blvd, Safaieh, YAZD Iran


Background: Epiglottitis is an inflammatory disease involving the epiglottis, vallecula, arytenoid cartilage, and aryepiglottic wrinkles. Acute epiglottitis is relatively rare, but it can quickly lead to a life-threatening airway obstruction. Diagnosis of epiglottitis is clinical, but radiography and direct vision of the epiglottis can also help with the diagnosis. Clinical manifestations of epiglottitis include fever, sore throat, and in the event of imminent airway obstruction, symptoms of muffled sound, falls, tripod position, and stridor might be presented as well. Epiglottitis can be caused by some bacterial agents or viruses such as adenovirus and measles. COVID-19 was first detected in December 2019 in a group of patients with severe respiratory symptoms in Hubei Province, China. Common symptoms include fever, cough, fatigue, difficulty breathing, and loss of smell and taste. Although COVID-19 disease has a variety of manifestations, only one case of epiglottitis following COVID-19 disease has been reported in adults. However, no cases of epiglottitis have been reported in children with COVID-19.
Case presentation: The patient, a 4-year-old boy, came to our center and the patient's family complained about shortness of breath and progressive lethargy of the child from 10 days ago. Since last week, he had been sleeping in a sitting position due to the aggravation of shortness of breath. On physical examination, respiratory distress, tachypnea, subcostal retraction, tail stridor, and crackle was heard in both lungs. Diagnosed with suspected bronchoscopy epiglottitis; and a large, swollen, and cherry-red epiglottis was observed. Based on the patient's history of respiratory symptoms and the prevalence of COVID-19, a reverse pharyngeal polymerase (RT-PCR) transcript test was requested for COVID-19 and the COVID-19 infection was positive. The patient was intubated due to decreased oxygen scorching and was treated with antibiotics due to the diagnosis of epiglottitis and recovered.
Conclusion: In this article, we reported the case of a 4-year-old child with epiglottitis in the context of COVID19. To the best of our knowledge, no case of epiglottitis had been, previously, reported in children with COVID19. Therefore, in our opinion, epiglottitis can probably be one of the manifestations of COVID19 in children.


  1. Kim KH, Kim YH, Lee JH, Lee DW, Song YG, Cha SY, Hwang SY. Accuracy of objective parameters in acute epiglottitis diagnosis: A case-control study. Medicine. 2018; 97:e12256.
  2. Dowdy R, Cornelius B. Medical Management of Epiglottitis. Anesthesia Progress. 2020; 67:90-7.
  3. Rodríguez-González M, Castellano Martinez A, Cascales-Poyatos H, Perez Reviriego Á. Cardiovascular impact of COVID-19 with a focus on children: A systematic review. World Journal of Clinical Cases. 2020; 8:5250-83.
  4. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological Associations of COVID-19. SSRN Electronic Journal. 2020.
  5. Stafstrom C, Jantzie L. COVID-19: Neurological Considerations in Neonates and Children. Children (Basel, Switzerland). 2020; 7.
  6. Oliver C, Campbell M, Dylan O, Hamilton N, Birchall M. Appearance and management of COVID-19 laryngo-tracheitis: two case reports. F1000Research. 2020; 9:310.
  7. Chen T-H. Neurological involvement associated with COVID-19 infection in children. Journal of the Neurological Sciences. 2020.
  8. Kivekäs I, Rautiainen M. Epiglottitis, Acute Laryngitis, and Croup. 2018. p. 247-55.
  9. Fondaw A, Arshad M, Batool S, Robinson B, Patel T. COVID-19 infection presenting with acute epiglottitis. Journal of Surgical Case Reports. 2020; 2020(9).