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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Uncommon presentation of a common disease: influenza A presenting as adult croup 
  1. Nasreen Shaikh,
  2. Prudence Dy,
  3. Amrit Basnet,
  4. Shilpan Shah
  1. Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
  1. Correspondence to Dr Nasreen Shaikh, shaikh.drn{at}gmail.com

Summary

An 88-year-old woman presented to our emergency room with complaints of fever, coryza, barking cough and generalised fatigue for 2 days. Physical examination showed stridor, tachypnoea with use of accessory muscles of respiration on admission. Laboratory tests were unremarkable except for monocytosis with a normal total white cell count. Rapid influenza diagnostic test was positive for influenza A. Chest X-ray showed subglottic narrowing of the trachea suggestive of steeple sign. A diagnosis of influenza A-induced croup was made. She was given humidified oxygen, nebulised racemic epinephrine, intravenous dexamethasone and oseltamivir. Stridor resolved within minutes of giving nebulised epinephrine. Work of breathing improved within 4–6 hours. She was discharged 2 days later on a tapering dose of steroids.

  • influenza
  • radiology

https://doi.org/10.1136/bcr-2017-223974

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    Footnotes

    • Contributors NS and PD were on call and admitted the patient. They provided management. AB was the resident taking care of the patient while she was admitted for 2 days. SS was the attending physician taking care of the patient. The manuscript was written by NS and AB and edited by PD and SS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.