Breakthrough COVID-19 infection inducing acute epiglottitis in an immunized host

We present the case of a 32-year-old man vaccinated with the Johnson & Johnson coronavirus disease 2019 (COVID-19) vaccine who presented with pharyngodynia and breakthrough COVID-19 infection. The patient was diagnosed with severe acute respiratory syndrome coronavirus 2 infection via nasal swab and acute epiglottitis by imaging and flexible laryngoscopy. While COVID-19 is known to present with pharyngodynia, nasal congestion, rhinorrhea, and olfactory dysfunction, epiglottitis is not a typical presentation. Fewer than 10 cases of acute epiglottitis in the setting of COVID-19 have been reported. Independently, active COVID-19 infections can result in acute respiratory distress syndrome, while epiglottitis may lead to complete airway obstruction. The combination of these two conditions may lead to challenging clinical management.