Fatal COVID-19 in a Child with Persistence of SARS-CoV-2 Despite Extensive Multidisciplinary Treatment: A Case Report

Abstract

Critical Coronavirus disease 2019 (COVID-19) developed in a 7-year-old girl with a history of dystrophy, microcephaly, and central hypothyroidism. Starting with gastrointestinal symptoms, the patient developed severe myocarditis followed by progressive multiple organ failure complicated by Pseudomonas aeruginosa bloodstream infection. Intensive care treatment consisting of invasive ventilation, drainage of pleural effusion, and high catecholamine therapy could not prevent the progression of heart failure, leading to the implantation of venoarterial extracorporeal life support (VA-ECLS) and additional left ventricle support catheter (Impella® pump). Continuous venovenous hemofiltration (CVVH) and extracorporeal hemadsorption therapy (CytoSorb®) were initiated. Whole exome sequencing revealed a mutation of unknown significance in DExH-BOX helicase 30 (DHX30), a gene encoding a RNA helicase. COVID-19 specific antiviral and immunomodulatory treatment did not lead to viral clearance or control of hyperinflammation resulting in the patient’s death on extracorporeal life support-(ECLS)-day 20. This fatal case illustrates the potential severity of pediatric COVID-19 and suggests further evaluation of antiviral treatment strategies and vaccination programs for children.

Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

“…We identified 312 articles through the initial database search and the subsequent manual search. After removing 207 items based on the title and abstract, we reviewed the full text of 105 articles and included 44 studies (total number of ECMO use = 110) in the systematic review (8, 9, 11–14, 19–56). In particular, three studies with relatively large sample sizes (number of ECMO use = 42, 31, and 69) were excluded because they did not provide clinical data of patients on ECMO separately (57–59).…”

“…In particular, three studies with relatively large sample sizes (number of ECMO use = 42, 31, and 69) were excluded because they did not provide clinical data of patients on ECMO separately (57–59). Of the 44 articles, 18 were retrospective observational studies (8, 9, 14, 19–33), four were case series (11–13, 34), and 22 were case reports (35–56). Among the total of 22 observational studies and case series, 10 studies included only one ECMO patient (12, 14, 27–34).…”

“…ECMO use details are summarized in Supplemental Table 2 (http://links.lww.com/PCC/C260). The indications for ECMO were specified in 36 studies (8, 9, 11–13, 20–23, 27, 29–31, 33–48, 50–56). The two major indications for ECMO were MIS-C (52% [47/90]) and ARDS (42% [38/90]).…”

Remdesivir, Sinus Bradycardia and Therapeutic Drug Monitoring in Children With Severe COVID-19

“…In this girl, however, severe myocarditis leading to the need for extracorporeal life support (ECLS), hemofiltration, catecholamine-dosing and multiple other drugs could also have led to bradycardia. 2 Notably, in this patient, levels of RDV on day 5 and day 6 (2531 and 1938 ng/ml 1 h post-infusion, respectively) and its metabolite GS-441524 (trough level 239.5 and 291 ng/ml, respectively) were confirmed to be within target levels during ECLS and hemofiltration by the UHPLC-MS/MS method. 3 Sadly, both girls on ECLS finally succumbed due to fulminant COVID-19 despite multi-disciplinary intensive care.…”