PT - JOURNAL ARTICLE AU - Andreas Pfleger AU - Manfred Modl AU - Ernst Eber TI - Airway endoscopy is an important tool in children with atypical croup AID - 10.1183/13993003.congress-2016.PA3153 DP - 2016 Sep 01 TA - European Respiratory Journal PG - PA3153 VI - 48 IP - suppl 60 4099 - http://erj.ersjournals.com/content/48/suppl_60/PA3153.short 4100 - http://erj.ersjournals.com/content/48/suppl_60/PA3153.full SO - Eur Respir J2016 Sep 01; 48 AB - Background: Acute onset of barking cough, hoarseness, and stridor are characteristic for viral croup, which has to be differentiated from rare bacterial laryngotracheitis.Aim: To describe clinical features and findings in children with non-viral croup.Methods: We reviewed history and endoscopic findings in four consecutive cases with atypical croup.Results:Case 1: 23-month-old male with croup symptoms, no fever, normal blood count and CRP, marginal response to steroids and epinephrine; laryngeal ultrasound suspected haemangioma. Endoscopy: subglottic mucosal swelling with white membranes; culture: Haemophilus influenzae and Staphylococcus aureus.Case 2: 1.5-year-old girl with runny nose, hoarseness, barking cough and a biphasic stridor, subfebrile, SpO2 85%, normal blood count, CRP 59 mg/l, history of suspected aspiration (apple piece). Endoscopy: subglottic mucosal swelling, yellow fibrinous plaques narrowing the airway approx. 90%, no foreign body; culture: Streptococcus pyogenes.Case 3: 14-month-old boy, croup symptoms, subfebrile, normal blood count, CRP 45 mg/l, deterioration despite steroids and epinephrine. Endoscopy: white fibrinous membranes extending from the subglottis to the proximal trachea; culture: Streptococcus pyogenes.Case 4: 10-month-old infant with croup, subfebrile, normal blood count, CRP 14mg/l, marginal improvement to steroids and epinephrine. Endoscopy: subglottic white membranes, culture: Candida albicans.Conclusion: In contrast to medical textbooks, bacterial laryngotracheitis is not always accompanied by high fever and severe illness. Endoscopy and cultures from aspirates allow for establishing the diagnosis and distinguishing bacterial from fungal infections.