Dramatic improvement after tocilizumab of severe <scp>COVID</scp>‐19 in a child with sickle cell disease and acute chest syndrome

Odièvre, Marie‐Hélène; Marcellus, Charles de; Pointe, Hubert Ducou Le; Allali, Slimane; Romain, Anne-Sophie; Youn, Jenny; Taytard, Jessica; Nathan, Nadia; Corvol, Harriet

doi:10.1002/ajh.25855

Cited by 59 publications

(87 citation statements)

References 6 publications

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“…Furthermore, the association between acute chest syndrome in patients with SCD and SARS-CoV-2 infection is intriguing. Indeed, the high number of similar cases in the literature so far suggests a poor tolerance of COVID-19 in patients with SCD, probably due to the SCD vasculopathy that worsens SARS-CoV-2 pathogenicity in the lungs [ 19 , 20 , 21 , 22 , 23 ]. However, in the described teenagers, despite the severe initial presentation, even when burdened by a preexisting chronic disease such as SCD, obesity or epilepsy, no fatal evolution was observed in this pediatric series, and all of the patients recovered without any sequelae [ 22 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1–17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2–10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.

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Section: Discussionmentioning

confidence: 99%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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“…Given the pivotal role of IL‐6 signalling in CRS and its prognostic significance in COVID‐19, 40 there has been considerable interest in the therapeutic potential of the IL‐6 receptor antagonist, tocilizumab. Two separate case reports of the use of tocilizumab in acute chest syndrome of Sickle cell disease precipitated by COVID‐19 reported rapid responses in an adult 41 and a teenager 42 . Tocilizumab administration also resulted in clinical improvement in a patient with COVID‐19 and multiple myeloma 43 .…”

Section: Covid‐19 Cytokine Storm and Haematological Hyperinflammatorymentioning

confidence: 99%

Haematological manifestations of COVID‐19: From cytopenia to coagulopathy

Agbuduwe

Basu

2020

European J of Haematology

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“…She made rapid recovery and was discharged from the intensive care unit without the need of O2 therapy. 24…”

Section: Covid-19 In Scd: Clinical Experiencementioning

confidence: 99%

Challenges in the Management of Sickle Cell Disease During SARS-CoV-2 Pandemic

Alsayegh

Mousa

2020

Clin Appl Thromb Hemost

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The management of sickle cell disease (SCD) and its complications in the COVID-19 era is very challenging. The recurrent sickling process in SCD causes tissue hypoxemia and micro-infarcts, resulting in end organ damage. Since the outbreak of SARS-CoV-2 pandemic, little data has been published about SCD concerning clinical presentation with COVID-19 and management. Hydroxyurea has been the cornerstone of management in children and adults with SCD, with evidence of its effect on controlling end organ damage. There are several anti-sickling drugs that have been approved recently that might have an additive value toward the management of SCD and its complications. The role of simple and exchange transfusions is well established and should always be considered in the management of various complications. The value of convalescent plasma has been demonstrated in small case series, but large randomized controlled studies are still awaited. Immunomodulatory agents may play a role in reducing the damaging effects of cytokines storm that contributes to the morbidity and mortality in advanced cases. Prophylactic anticoagulation should be considered in every management protocol because SCD and COVID-19 are thrombogenic conditions. Management proposals of different presentations of patients with SCD and COVID-19 are outlined.

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Dramatic improvement after tocilizumab of severe COVID‐19 in a child with sickle cell disease and acute chest syndrome

Cited by 59 publications

References 6 publications

The Wide Spectrum of COVID-19 Clinical Presentation in Children

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Haematological manifestations of COVID‐19: From cytopenia to coagulopathy

Challenges in the Management of Sickle Cell Disease During SARS-CoV-2 Pandemic

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