(A703) Acute Laryngotracheitis as a Rare COVID-19 Complication in an Adult with Respiratory Failure

Introduction: Acute laryngotracheitis, commonly caused by human parainfluenza viruses, is a rare manifestation of COVID-19 in adults, though it is more frequently reported in children. We present a case of severe acute laryngotracheitis caused by COVID-19 in an adult patient with respiratory compromise, outlining her relevant history, clinical presentation, and treatment.

Methods: A case report and literature review are presented.

Results: A 55-year-old woman with a history of hoarseness, vocal cord polyps, and smoking presented with 10 days of progressively worsening symptoms, including hoarseness, sore throat, and dyspnea. She had not received a COVID-19 booster in several years. Initially managed with antibiotics and prednisone, her condition worsened with the onset of severe stridor, prompting her presentation to the emergency department. Upon arrival, the patient was unable to speak due to severe shortness of breath and exhibited significant respiratory distress. Examination revealed vocal cord swelling, and a difficult intubation was performed, requiring a 6.5 mm endotracheal tube due to edema. A chest X-ray was nonremarkable. Computed tomography imaging revealed an infectious process involving the palatine tonsils, nasopharyngeal tissues, bilateral pleural effusions, and parenchymal opacities. The epiglottis was obscured by support tubes, and small retropharyngeal fluid collections were noted. COVID-19 testing was positive, and the patient was started on remdesivir and dexamethasone. Hypotension developed, requiring norepinephrine. She was admitted to the intensive care unit for close monitoring and remains intubated. Additional details, including a 6-month follow-up and photos, will be included with the poster.

Conclusions: COVID-19 can present with acute laryngotracheitis and vocal cord swelling, leading to severe airway compromise. A high index of suspicion and early intubation are essential for managing these cases, particularly as vaccination rates decline and self-testing remains limited.