Severe Pediatric COVID-19 Presenting With Respiratory Failure and Severe Thrombocytopenia

American Academy of Pediatrics (AAP) - Tập 146 Số 1 - 2020
Pratik A. Patel1, Shanmuganathan Chandrakasan1, Geoffrey E. Mickells2, İnci Yıldırım3, Carol Kao3, Carolyn M. Bennett1
1Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia;
2Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia; and
3Division of Infectious Disease, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia

Tóm tắt

The novel severe acute respiratory syndrome coronavirus 2 is a worldwide pandemic. The severe morbidity and mortality associated with coronavirus disease 2019 has mostly affected the elderly or those with underlying medical conditions. We present a case of a 12-year-old girl with no past medical history who presented with fever, cough, and vomiting. Laboratory evaluation revealed severe thrombocytopenia and elevated markers of inflammation. The patient progressed to respiratory failure, and testing results for the severe acute respiratory syndrome coronavirus 2 returned positive. Because of the severity of her thrombocytopenia, she was treated with intravenous immunoglobulin and steroids with prompt improvement in platelets. The patient’s severe acute respiratory distress syndrome was managed with mechanical ventilation, inhaled nitric oxide, and then airway pressure release ventilation. After azithromycin and hydroxychloroquine were given without improvement, our patient received tocilizumab, an anti–interleukin-6 receptor antibody, and remdesivir, a broad antiviral agent, with significant clinical benefit soon afterward. Given that severe pediatric coronavirus disease 2019 is rare, we hope to inform pediatric providers on the clinical course and management considerations as this pandemic continues to spread.

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American Academy of Pediatrics (AAP)

Tập 146 Số 1

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