Coronavirus disease 2019 in a 13-year-old patient with acute lymphoblastic leukemia

Hossaini, Seyed Kamal Eshagh; Movahedi, Zahra; Hormati, Ahmad; Heydari, Hossein; Hosseini, Seyed Jalal Eshagh; Khodadust, Fatemeh; Afifian, Mahboubeh; Ahmadpour, Sajjad

doi:10.3345/cep.2020.01711

Clin Exp Pediatr

2021

DOI: 10.3345/cep.2020.01711

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Coronavirus disease 2019 in a 13-year-old patient with acute lymphoblastic leukemia

Seyed Kamal Eshagh Hossaini

Zahra Movahedi

Ahmad Hormati

et al.

Abstract: What should be considered in an immunocompromised child with coronavirus disease (COVID-19)? Finding: Due to the importance of appropriately managing COVID-19 in children with cancer, the possibility of a fatal outcome should be considered in immunocompromised patients who receive chemotherapy agents. Meaning: In all kinds of infections including COVID-19, disuse management and the development of international guidelines for children with cancer is challenging but important.

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A 13-year-old girl developed COVID-19 during treatment with doxorubicin, pegaspargase, prednisolone and vincristine for acute lymphoblastic leukemia (ALL).The girl was admitted to a hospital in Iran on 2 March 2020 with pallor, anaemia and weight loss. Following further investigation, she was diagnosed with ALL with T-cell type. She started receiving chemotherapy with doxorubicin, pegaspargase [Oncaspar; PEG-L-Asparaginase], prednisolone and vincristine [routes and dosages not stated]. However, on 12 March 2020, she was again hospitalised with vomiting and fever. She also reported gingival bleeding, myalgia and cough. A real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cycle threshold (Ct) value was 25. A chest CT scan demonstrated a well-defined nodular ground-glass opacity with diameter of 6mm at lateral segment of right middle lobe. Laboratory investigations were performed. Gasometer data were in normal range [time to reaction onset not clearly stated].The girl received off-label treatment with hydroxychloroquine, lopinavir/ritonavir and oseltamivir for COVID-19. Within 2 weeks, all symptoms for COVID-19 subsided. Repeat rRT-PCR test was found to be negative for SARS-CoV-2 with Ct value of 39. Radiologic findings also disappeared. On 18 April 2020, she was hospitalised and received chemotherapy with doxorubicin, pegaspargase, prednisolone and vincristine for third time. However, 3 days later, she was hospitalized again with the main complaint of fever, diarrhoea, abdominal pain, headache and nausea. At the beginning of hospitalisation, she experienced tonic-clonic seizures twice and lost consciousness. Drowsiness and stiff neck were also noted. Chest CT scan showed small bilateral peripheral consolidations with ground-glass opacity and a crazy paving pattern. The rRT-PCR test was found to be positive for SARS-CoV-2 with Ct value of 27. She was again diagnosed with COVID-19. She received off-label treatment with lopinavir/ritonavir, oseltamivir, methylprednisolone and IV immune globulin [immunoglobulin] for COVID-19. She also received levetiracetam, platelets, dopamine, plasma [fresh frozen plasma] and pethidine. However, eventually, her lung turned white. She developed multisystem inflammatory syndrome in children (MIS-C) according to the WHO diagnostic criteria for MIS-C9. Subsequently, she developed acute respiratory distress syndrome and cardiovascular arrest and died. Chemotherapy with doxorubicin, pegaspargase, prednisolone and vincristine was suspected to have contributed in the development of

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Coronavirus disease 2019 in a 13-year-old patient with acute lymphoblastic leukemia

Cited by 1 publication

References 8 publications

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