Varicella with stridor: think group A streptococcal epiglottitis

Area of Science:

• Pediatrics
• Infectious Diseases
• Otolaryngology

Background:

• Varicella (chickenpox) is a common viral illness in children.
• Bacterial superinfections frequently complicate varicella, but are typically cutaneous.
• Airway complications secondary to varicella are exceptionally rare.

Observation:

• A 2-year-old boy presented with varicella.
• The child developed severe, life-threatening stridor.
• The stridor was attributed to group A streptococcal epiglottitis.

Findings:

• Group A Streptococcus (GAS) can cause epiglottitis.
• GAS epiglottitis is a rare but severe complication of varicella.
• This case underscores the potential for invasive GAS infections in the setting of viral exanthems.

Implications:

• Early recognition of airway compromise is critical in children with varicella.
• Prompt diagnosis and treatment of bacterial epiglottitis are essential for favorable outcomes.
• This case emphasizes the importance of considering invasive bacterial infections beyond typical skin manifestations in varicella patients.