Faculty Collaboration Database

Ulcerative lesions as a rare cause of laryngotracheitis in the pediatric population. Am J Otolaryngol 2013;34(5):541-4

Date

03/29/2013

Pubmed ID

23535210

DOI

10.1016/j.amjoto.2013.02.007

Scopus ID

2-s2.0-84883216700 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

OBJECTIVE: The goal of this study is to describe a unique finding of ulcerative lesions of the larynx in two pediatric patients presenting with prolonged acute laryngotracheitis and compare to previously described reports to determine the typical clinical picture, need for intervention, and management model.

METHODS: We present two cases of ulcerative lesions of the larynx in immunocompetent children, one with PCR positive HSV, which presented as severe croup requiring intensive care unit admission. Literature review was completed to assess for current knowledge of this entity. Our cases are discussed in the context of previously reported cases of HSV laryngotracheitis. Descriptive analysis was completed focusing on presentation, physical exam findings, treatment, length of therapy, and outcomes.

RESULTS: Literature review uncovered six case reports including 10 individual cases of prolonged croup with findings of HSV laryngitis and one retrospective review describing 15 cases of prolonged croup found to be caused by ulcerative laryngitis. All patients underwent direct laryngoscopy and bronchoscopy for evaluation. Analysis was completed comparing the studies to our patients with significant findings including high intubation rate of 77%, ulcerative stomatitis in 63%, and treatment with antiviral medication directed at HSV in 85% with improvement in symptoms.

CONCLUSION: It is important to consider HSV as a possible pathogen in cases of prolonged or atypical croup. Laryngoscopy should be used for diagnostic intervention and identification of ulcerative lesions. Stomatitis may be an indication for earlier direct inspection. Treatment with anti-viral therapy and with discontinuation or taper of steroid is suggested.

Author List

O'Niel MB, Chun RH, Conley SF

Author

Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Diagnosis, Differential
Humans
Infant
Laryngitis
Laryngoscopy
Larynx
Male
Tracheitis
Ulcer