SARS-CoV-2 infection can cause croup, according to a new case report. The 14-month-old boy presented to a community emergency department with fever, cough and stridor, and did not have pneumonia or lower-respiratory-tract infection, Dr. Claire E. Pitstick of Rush University Medical Center in Chicago and her colleagues report in Pediatrics. "My take-home message is to always keep COVID on the differential diagnosis, because it can present in so many different ways," Dr. Pitstick told Reuters Health by email. "This is why it is so important for providers to have adequate PPE and for clinics to have access to sufficient SARS-CoV-2 testing, ideally rapid point-of-care testing. In our patient, the diagnosis of COVID did not change the way we treated the croup itself, but we were able to educate the family on self-isolation to prevent transmission." The boy presented to the emergency department in early May 2020 with difficulty breathing and a fever of 39.3 C. He was tachycardic initially, with blood pressure of 103/85 mm Hg and respiratory rate of 40 breaths per minute. His oxygen saturation was 100% while breathing room air. He was treated at the emergency department with racemic epinephrine and dexamethasone and transferred to the authors' quaternary-care center to be observed overnight. He was discharged the next day with supportive care and outpatient follow-up. The parents had not vaccinated the boy for religious reasons, Dr. Pitstick noted. While being unvaccinated was unlikely to be a factor in him contracting COVID croup, "the influenza vaccine may have prevented our patient from being hospitalized for influenza A in February 2020," she added. "Before discharging our patient, I strongly encouraged the father to schedule catchup vaccines with their pediatrician. He said he would consider it, because he had seen how dangerous respiratory illnesses can be, and he did not want his son to be hospitalized again," Dr. Pitstick said. "Luckily, our patient recovered quickly from croup without short-term complications. However, since his outpatient pediatrician is not connected to Rush, we were unable to follow up on whether he seroconverted (produced COVID antibodies) or developed any long-term complications," she added. "We recommend that when a child is diagnosed with COVID - inpatient or outpatient, symptomatic or asymptomatic - it should be added to their medical history in order to monitor for secondary effects, such as multi-system inflammatory syndrome in children (MIS-C) and other long-term outcomes," Dr. Pitstick concluded. —Anne Harding
