Since little is known about dysregulated hyperinflammatory immunological responses causing acute severe infection and multisystem inflammatory syndrome in children associated with coronavirus disease 2019 (COVID-19), the available data on therapies for severe presentations in children are very limited. Describing experiences of severe pediatric COVID-19 presentations in more detail will help improve clinical practice.In this case report, we describe the complete clinical course of a 9-year-old girl previously diagnosed with Angelman syndrome and high-risk T cell acute lymphoblastic leukemia who had been receiving reinduction chemotherapy, presented with pneumonia and acute respiratory distress syndrome, and progressively developed hyperferritinemic multiple-organ failure, a cytokine storm, and coagulopathy associated with COVID-19. She was treated with therapeutic plasma exchange, tocilizumab, hydrocortisone, and favipiravir, but she died 7 days after her admission into our pediatric intensive care unit.The utility of therapeutic plasma exchange with other immunomodulatory therapies in severe presentations requires further trials. The spectrum of the inflammatory phenotypes associated with COVID-19 should be investigated and well defined to initiate the optimal treatment strategy on time.
Background: Data on the outcome and risk factors of pediatric
patients with SARS-CoV-2 infection (COVID-19) following hematopoietic
stem cell transplantation (HSCT) are limited. Objectives: We
aimed to describe risk factors for a severe course and mortality.
Method: In this nationwide study, data were collected
retrospectively from 28 transplant centers. Results: One
hundred ninety-six children [(63.8% male; median age 8.75 (IQR,
4.86-14.30)] who received allogeneic (n: 184, 93.9%) or autologous
(n: 12, 6.1%) HSCT were included. The median time from HSCT to
SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common
clinical manifestation was fever (58.2%), followed by cough (33.7%);
43 cases (21.9%) were asymptomatic. Lower respiratory tract disease
(LRTD) and multisystem inflammatory syndrome in children (MIS-C)
developed in 58 (29.6%) and 8 (4.1%) patients, respectively.
Twenty-six patients (13.3%) required ICU admission. Nine patients died
at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of
whom died due to the disease, with a COVID-19 lethality rate of 3.1%.
The 6-week overall survival was 95.4% (95% CI 92.5-98.3). Multivariate
analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039)
and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU
admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p:
0.030) at diagnosis were risk factors for mortality.
Conclusion: Overall mortality was lower in children than in
adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD,
MIS-C and ICU admission were important risk factors for adverse
outcomes.
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