Published: 2021-10-25

Croup as a manifestation of COVID-19 in infancy: a case series

Bhakti Sarangi, Guruprasad H. Shankar, Ajay Walimbe, K. C. Prithvichandra


The second wave of the COVID-19 pandemic in India brought with it an emerging clinical spectrum of the infection in children. Amongst these is the rarely reported presentation of croup, which otherwise remains a common clinical condition in infants caused by a variety of viruses and seen by pediatricians regularly. Airway manifestations of COVID-19 require reporting and unless their evaluation brings up any specific peculiarities, it is imperative to screen all such children presenting to the emergency department for SARS-CoV-2 infection. We hereby reported a series of three infants who were brought to us with typical features of croup including a mild fever, runny nose and indicators of subglottic inflammation including a hoarse voice, brassy cough and an inspiratory stridor. Each of them responded to conventional therapies for croup. However, the added conundrum of possible SARS-CoV-2 infection increases the relevance of rapid screening, assessment for complications and counselling in children presenting with croup.


SARS-CoV-2, Croup, Acute laryngotracheitis, Stridor, Budesonide

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Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of SARS-CoV-2 infection in children: a systematic review and meta-analysis. Indian Pediatr. 2020;57(9):820-6.

Sarangi B, Shankar GH, Reddy VS. Virus-induced wheezing with COVID-19. Indian Pediatr. 2020;57(12):1183-5.

Venn AMR, Schmidt JM, Mullan PC. A case series of pediatric croup with COVID-19. Am J Emerg Med. 2020;735(20):30829.

Pitstick CE, Rodriguez KM, Smith AC, Herman HK, Hays JF, Nash CB. A curious case of croup: laryngotracheitis caused by COVID-19. Pediatrics. 2021;147(1):2020012179.

Rodrigues KK, Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliengman RM, Geme JWS, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Text book of pediatrics. 21st ed. Philadelphia: Saunders Elsevier; 2019: 2202-6.

Hoek LV, Sure K, Ihorst G, Stang A, Pyrc K, Jebbink MF, et al. Croup is associated with the novel coronavirus NL63. PLoS Med. 2005;2(8):240.

Hanna J, Brauer PR, Morse E, Berson E, Mehra S. Epidemiological analysis of croup in the emergency department using two national datasets. Int J Pediatr Otorhinolaryngol. 2019;126:109641.

Ortiz-Alvarez O. Acute management of croup in the emergency department. Paediatr Child Health. 2017;22(3):166-9.

RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384(8):693-704.

Ramakrishnan S, Nicolau DV, Langford B, Mahdi M, Jeffers H, Mwasuku C, et al. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. Lancet Respir Med. 2021;9(7):763-72.

Aghdam MK, Mirzaee HS, Eftekhari K. Croup is one of the clinical manifestations of novel Coronavirus in children. Case Rep Pulmonol. 2021;2021:8877182.