The First Presentation of Pediatric COVID-19 With Diabetic Ketoacidosis: A Unique Case Report

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, is a pandemic infectious disease involved all over the world. Its mortality, especially in cases with additional co-morbidities, is so high that is has attracted the attention of the world. Diabetes mellitus is known as one of its risk factors for mortality. Case Presentation: A unique case of pediatrics COVID-19 who presented with diabetic ketoacidosis (DKA) is reported in this manuscript as the first presentation. He presented with abdominal pain, nausea, and vomiting. RT-PCR test for COVID-19 via nasal swab was performed, and a positive diagnosis was obtained. Chest CT scan confirmed the diagnosis with multifocal bilateral patchy consolidation. Case was discharged after usual treatment of COVID-19. Conclusion: In pediatrics, this disease can be subtle and have a confusion presentation, but it should be controlled to avoid spread of the disease. During epidemic status, suspicious cases specially children with nonspecific symptoms and other underlying diseases should be considered as at risk or potentially asymptomatic COVID-19 cases.

An overview of the COVID‐19 complications in paediatric population: A pandemic dilemma

“…A nasal swab RT‐PCR test for COVID‐19 was performed, and a positive diagnosis was obtained. A chest CT scan revealed multifocal bilateral patchy consolidation, confirming the diagnosis 74 …”

New-Onset Type 1 Diabetes in Children With SARS-CoV-2 Infection

“…The increased incidence may be due to acute infection with SARS-CoV-2 much like other viral illnesses or the result of living in a pandemic where parents are less likely to seek medical care for their children due to fear of exposure or reduced access to primary care services. It has also been noted that there is an increase in the occurrence of new-onset type 1 DM in the pediatric population with few reports of concurrent SARS-CoV-2 infection [5][6][7][8].…”

“…There have been few anecdotal reports worldwide of SARS-CoV-2 infection precipitating DKA in children with no pre-existing diagnosis of type 1 DM [5][6][7][8]. However, it is unclear from these reports whether SARS-CoV-2 directly triggered DKA or if concomitant infection precipitated DKA in a child whose diagnosis was delayed due to decreased access to medical services during the pandemic.…”

“…There have been reports worldwide on new-onset DM in SARS-CoV-2 patients and increased incidence of diabetic ketoacidosis (DKA) in those with pre-existing DM [2][3][4]. This trend has also been noted in children during the pandemic, with a rise in both the incidence of new-onset type 1 DM and presentation in DKA [5][6][7][8].…”

Diabetic ketoacidosis in children induced by coronavirus disease 2019 (COVID-19) diabetic ketoacidosis post-COVID-19 in children

“…Similarly, presence of thyroid peroxidase antibody in second indicates autoimmunity against thyroid. To the best of our knowledge, there have been isolated cases of DKA in children post-COVID-19 [ 10 ]. Ours is the first case series where both these patients developed severe metabolic complications along with other autoimmunity markers post-COVID-19.…”