This clinical observation is an example to show the complexity of diagnosing and treating children with SARS-CoV-2-associated multisystem inflammatory syndrome. A 17-year-old patient who had a mild form of COVID-19 two weeks ago had a fever again and felt severe abdominal pain, and his general condition deteriorated rapidly. Moreover, on the fifth day from the onset of the disease, a child from the district hospital was admitted to the Ivano-Matreninsky Childrens Hospital in critical condition. Due to peritoneal symptoms, a diagnostic laparoscopy was performed to exclude acute surgical diseases which revealed mesadenitis and hydroperitoneum. Subsequently, the patient had a prolonged fever, severe multiple organ failure developed, including myocarditis with damage to the conduction system of the heart and a marked decrease in the left ventricular ejection fraction, bilateral pneumonia, hydroperitoneum and hydrothorax, acute kidney injury, lymphopenia, thrombocytopenia, coagulopathy, increased markers of inflammation. Non-invasive artificial lung ventilation was performed for 3 d. On day 10, an atrial temporary pacing system was installed, removed 11 d after heart rhythm normalization, and the pleural cavity was drained due to spontaneous pneumothorax. There was a gradual positive trend in respiratory status, the state of the cardiovascular system, normalization of laboratory parameters, and a decrease in inflammation markers. The patient was discharged from the hospital in a satisfactory condition on day 39. This clinical case demonstrates a severe course of childhood inflammatory, multisystem syndrome with multiple organ failure. The peculiarities of the case include the severity of abdominal pain syndrome, requiring laparoscopy, impaired cardiac activity, and requiring a pacemaker for 11 days.
BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults. CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m2, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acidbase balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation. CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.
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