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• W2894935590 abstract "SESSION TITLE: Critical Care 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Croup (laryngotracheitis) is a rare disease in adults.Most cases occur in the fall or early winter. No cases have been reported occurring in the summer.We present a case of adult croup secondary to parainfluenza 2 virus occurring in the summer. CASE PRESENTATION: A 21 year old woman presented to the hospital for complain of sore throat in the last few days followed by acute onset dyspnea and the feeling that her throat was closing.She was working in a summer camp for kids where a croup outbreak was reported. Para-influenza virus 2 was isolated from respiratory secretions of the affected kids.On presentation she was afebrile, hypoxic saturating 94% on room air.She was in severe respiratory distress,unable to speak in full sentences,using her accessory muscle with evidence of dramatic inspiratory and expiratory stridor and diminished breath sounds bilaterally.Her white count was normal.Chest XR was remarkable for subglottic stenosis.Soft tissue ultrasound showed normal epiglottis silhouette, but severe swelling of the aryepiglottic folds with glottic and subglottic stenosis.Westley severity croup score was 12. She was emergently intubated.Neck CT demonstrated severe hypertrophy of the nasopharyngeal adenoids which completely effaces the nasopharyngeal airway.Viral respiratory panel was positive for Para-influenza virus 2. Urine Strep pneumonia antigen, mycoplasma antigen and microbiology remained negative.She was treated with racemic epinephrine, intravenous steroids and bronchodilators.Within 72 hours the patient made a complete clinical recovery.After two days she was successfully extubated. Follow up chest XR demonstrated resolution of subglottic narrowing. DISCUSSION: There are only 15 cases of adult croup reported in the literature.Usual presentation include fever, “barking” cough, dyspnea, stridor, hoarseness.Prodromal upper respiratory symptoms and stridor are more common in adults like in our case.Parainfluenza virus type 1 is the most common cause of croup, but respiratory syncytial virus (RSV), adenovirus and influenza virus can be implicated.Among adults the organisms identified in 33% cases included parainfluenza virus 3, Haemophilus influenzae, influenza, Streptococcus pneumoniae and RSV.The diagnosis of croup is clinical, based on presenting symptoms. Neither radiographs nor laboratory tests are necessary to make the diagnosis.The “steeple sign” is more common in adults with an incidence of 92% compared to 26% pediatric cases. Adults afflicted by croup have a more severe disease course and longer hospitalization.The data shows that 87% adults were admitted to ICU and 47% adults required intubation versus 12% pediatric cases.Corticosteroids and nebulized epinephrine remain the cornerstones of therapy. CONCLUSIONS: The index case represents the 16th case of adult croup. This is the first case of adult croup caused by Parainfluenza virus type 2 and occuring in the summer. Reference #1: Jayshil J. Patel, Emily Kitchin, and Kurt Pfeifer. A Narrowing Diagnosis: A Rare Cause of Adult Croup and Literature Review. Case Reports in Critical Care Volume 2017 (2017), Article ID 9870762 Reference #2: T. Parimon, N. B. Charan, D. K. Anderson, and P. G. Carvalho, “A catastrophic presentation of adult croup,” American Journal of Respiratory and Critical Care Medicine, vol. 187, no. 12, pp. e23–e24, 2013. Reference #3: P. C. Y. Woo, K. Young, K. W. T. Tsang, C. G. C. Ooi, M. Peiris, and K.-Y. Yuen, “Adult croup: a rare but more severe condition,” Respiration, vol. 67, no. 6, pp. 684–688, 2000. DISCLOSURES: No relevant relationships by Mohanad Almahmoud, source=Web Response No relevant relationships by Gabriela Ciofoaia, source=Web Response No relevant relationships by Jonila Murati, source=Web Response" @default.
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• W2894935590 date "2018-10-01" @default.
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• W2894935590 title "CROUP STRIKES AGAIN: A RARE CASE OF SEVERE CROUP CAUSED BY PARA-INFLUENZA VIRUS TYPE 2 IN ADULT" @default.
• W2894935590 doi "https://doi.org/10.1016/j.chest.2018.08.222" @default.
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