{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:08:56Z","timestamp":1789736936280,"version":"4.0.1"},"reference-count":7,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    SARS-CoV-2 infection in children is typically mild, although COVID-19-associated croup can be severe. We report a patient in middle childhood with impending critical airway obstruction due to severe subglottic oedema and extensive inflammatory slough\/crusting following SARS-CoV-2 infection. Subsequent airway assessment in the operating theatre revealed critical subglottic narrowing. During transport, nebulised epinephrine was initiated; however, the patient developed hypoxaemia (SpO\n                    <jats:sub>2<\/jats:sub>\n                    80%) with loss of consciousness. On arrival, video-laryngoscopic removal of obstructive slough using Magill forceps and Yankauer suction restored spontaneous ventilation with forceful expectoration of residual debris. Because of persistent severe oedema, endotracheal intubation required a markedly undersized tube for the patient\u2019s predicted size (internal diameter 4.5 mm). Following unplanned self-extubation on day 1, residual subglottic oedema and slough were managed with nebulised epinephrine and dexamethasone without re-intubation. The patient was discharged on day 10 without complications. This case highlights the importance of definitive airway management in a controlled setting.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-273982","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:00:19Z","timestamp":1789736419000},"page":"e273982","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Critical airway obstruction associated with extensive subglottic inflammatory slough and oedema following severe acute respiratory syndrome SARS-CoV-2 infection in a child"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9446-8909","authenticated-orcid":false,"given":"Yoichiro","family":"Ota","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Omura","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026091806001046000_19.9.e273982.1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-056492","article-title":"COVID-19-Associated Croup in Children","volume":"149","author":"Brewster","year":"2022","journal-title":"Pediatrics"},{"key":"2026091806001046000_19.9.e273982.2","doi-asserted-by":"crossref","DOI":"10.1002\/emp2.13053","article-title":"Outcomes of croup in children: COVID-19 versus non-COVID-19 cases","volume":"4","author":"Mendez","year":"2023","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"2026091806001046000_19.9.e273982.3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-012179","article-title":"A Curious Case of Croup: Laryngotracheitis Caused by COVID-19","volume":"147","author":"Pitstick","year":"2021","journal-title":"Pediatrics"},{"key":"2026091806001046000_19.9.e273982.4","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-244769","article-title":"Croup and COVID-19 in a child: a case report and literature review","volume":"14","author":"Lim","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026091806001046000_19.9.e273982.5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ajem.2020.09.034","article-title":"Pediatric croup with COVID-19","volume":"43","author":"Venn","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2026091806001046000_19.9.e273982.6","article-title":"Croup Is One of the Clinical Manifestations of Novel Coronavirus in Children","volume":"2021","author":"Kamali Aghdam","year":"2021","journal-title":"Case Rep Pulmonol"},{"key":"2026091806001046000_19.9.e273982.7","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1002\/lary.28141","article-title":"Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes","volume":"130","author":"Naina","year":"2020","journal-title":"Laryngoscope"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273982","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:00:20Z","timestamp":1789736420000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273982"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":7,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,18]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-273982"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273982","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}