Abstract Respiratory Syncytial Virus (RSV) is a leading cause of lower respiratory tract infection in children, and severe manifestations such as upper airway involvement in adults is rare. This case underscores the importance of early recognition and aggressive airway management in RSV-associated laryngeal disease, which can be life-threatening despite the absence of parenchymal lung pathology.A 69-year-old female presented to the emergency department with cough and shortness of breath. She had recently returned from the United States wherein she was reported to have fever and hoarseness of voice. On evaluation, patient had episodes of desaturation, physical examination showed stridor and wheezing on chest auscultation and was placed on oxygen support Laboratory tests were done and arterial blood gas revealed compensated respiratory acidosis with adequate oxygenation. Chest radiograph was unremarkable, and respiratory viral panel tested positive for Respiratory Syncytial Virus. For the clinical course, the patient developed sudden-onset respiratory distress and decreased sensorium, prompting emergency intubation and initiation of mechanical ventilation. She was started on intravenous dexamethasone and referred to otolaryngology department due to narrow airway passage and persistently high peak pressures on ventilator. A flexible nasopharyngolaryngoscopy revealed diffuse laryngeal edema with hyperemic mucosa, consistent with severe viral laryngitis. Despite optimal medical management and corticosteroid therapy, the airway obstruction persisted with Computed tomography imaging of the neck and upper airway revealed edema along the track of the endotracheal tube, prompting surgical tracheostomy to secure the airway.Following tracheostomy and continued corticosteroid therapy, the patient’s respiratory status improved markedly. She was successfully weaned off mechanical ventilation, and the tracheostomy tube was eventually de-cannulated. No recurrence of airway compromise was noted on follow-up laryngoscopy and patient was discharged.This case emphasizes the rare and critical manifestation of RSV infection in adults—severe laryngeal edema resulting in acute airway obstruction. Clinicians should maintain a high index of suspicion for upper airway involvement when patients present with hoarseness, stridor, or respiratory distress. Early laryngoscopic evaluation, timely corticosteroid administration, and prompt airway intervention are essential to prevent fatal outcomes. Recognition of this manifestations and complications expands the understanding of RSV’s clinical spectrum and emphasizes that adult RSV infection can progress from mild viral illness to airway crisis requiring invasive procedures. This abstract is funded by: NONE
Arceño et al. (Fri,) studied this question.