International Journal of Contemporary Pediatrics | November 2021 | Vol 8 | Issue 11 Page 1884 International Journal of Contemporary Pediatrics Sarangi B et al. Int J Contemp Pediatr. 2021 Nov;8(11):1884-1886 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 Case Series Croup as a manifestation of COVID-19 in infancy: a case series Bhakti Sarangi*, Guruprasad H. Shankar, Ajay Walimbe, K. C. Prithvichandra INTRODUCTION In the first wave of the pandemic, SARS-CoV-2 infection was found to be a milder ailment in children with the common symptoms apart from fever being predominantly respiratory in nature in the form of cough, sore throat and coryza with the occasional child demonstrating fast breathing and hypoxia. 1 As the pandemic has evolved newer clinical presentations have come to the fore including with the rare occurrence of virus induced wheezing also being reported. 2 Similarly, the picture of upper airway obstruction as seen in croup manifesting with stridor amongst other classical features have only seldom been reported as a part of the SARS-CoV-2 clinical spectrum in children, with no such reports from India. 3,4 We hereby reported a series of three infants with SARS-C0V-2 infection who were brought to us in a span of one month (between 15 March and 15 April 2021) with the typical manifestations of acute laryngotracheitis with the presence of an audible stridor, all of whom responded to treatment with oxygen, nebulized epinephrine and steroids. Our objective was to alert fellow pediatricians to this particular manifestation of COVID-19 in infancy and discuss the practical considerations involved with the assessment, diagnosis and management of these children. CASE SERIES In the peak of the second wave of the COVID-19 pandemic, we saw 3 infants brought to us with typical features of croup (Table 1). Of the 3 infants, two were male. All 3 had a prodrome of fever, runny nose and a brassy cough in addition to change in voice and an audible stridor. Two infants tested positive for SARS- CoV-2 by rapid antigen while one tested negative for antigen but positive by real time polymerase chain reaction (RT-PCR) of nasopharyngeal swab. Two infants had a moderate disease while one had a mild disease. The infants with moderate disease received epinephrine and ABSTRACT 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. Keywords: SARS-CoV-2, Croup, Acute laryngotracheitis, Stridor, Budesonide Department of Pediatrics, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India Received: 10 August 2021 Revised: 03 September 2021 Accepted: 11 October 2021 *Correspondence: Dr. Bhakti Sarangi, E-mail: dr.bhaktisarangi@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20214164