Ulcerative supraglottitis - a unique presentation of COVID-19 infection.

Objective: COVID-19 has been previously considered a lower respiratory tract disease. However, as the disease has evolved, studies have described its upper respiratory involvement. This study's objective was to present, for the first time, a series of patients with supraglottitis with unique characteristics of coronavirus disease.

Methods: This retrospective single-center case study included patients who were referred to the Emergency Department (ED) between June 1, 2022, and September 1, 2023, with clinical and endoscopic findings consisting of supraglottitis and positive PCR results for SARS-CoV-2.

Results: Ten patients met the inclusion criteria. The mean age was 61. Six (60%) patients had comorbidities. Two (20%) patients were not vaccinated, whereas the others were vaccinated between one and five times. All patients presented with odynophagia, and most had fever and hoarseness. Laryngeal findings included epiglottic ulcers in the inner portion of the epiglottis in all patients, with varying degrees of severity. Presentation with a choking sensation, hoarseness, and elevated CRP and WBC levels may indicate a more severe disease course.

Conclusion: The latest COVID-19 variants can manifest with clinical and endoscopic findings of acute supraglottitis, with specific endoscopic characteristics of the larynx. Physicians should be aware of this clinical entity, refer suspected patients to the ED, and perform urgent laryngoscopy, while the otolaryngologist should be aware of the specific endoscopic presentation and manage the patient accordingly.

Level of evidence: 4: This study was approved by the institutional review board. Approval number- 0212-23ASF- 22/09/2023.