CC BY 4.0 · Journal of Child Science 2020; 10(01): e240-e245
DOI: 10.1055/s-0040-1721513
Case Report

A Fatal Case of COVID-19 in a Child with ALL: A Cytokine Storm and Hyperferritinemic MODS

Fulya Kamit
1  Faculty of Medicine, Pediatric Intensive Care Unit, Istanbul Yeniyuzyil University, Istanbul, Turkey
,
Baris Malbora
2  Faculty of Medicine, Pediatric Hematopoetic Stem Cell Transplant Unit, Istanbul Yeniyuzyil University, Istanbul, Turkey
,
Avni Atay
2  Faculty of Medicine, Pediatric Hematopoetic Stem Cell Transplant Unit, Istanbul Yeniyuzyil University, Istanbul, Turkey
,
Derya Turan Bayirli
3  Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul Yeniyuzyil University, Istanbul, Turkey
,
Metin Bektas
4  Faculty of Medicine, Department of Anesthesiology, Istanbul Yeniyuzyil University, Istanbul, Turkey
› Author Affiliations

Abstract

Since little is known about dysregulated hyperinflammatory immunological responses causing acute severe infection and multisystem inflammatory syndrome in children associated with coronavirus disease 2019 (COVID-19), the available data on therapies for severe presentations in children are very limited. Describing experiences of severe pediatric COVID-19 presentations in more detail will help improve clinical practice.

In this case report, we describe the complete clinical course of a 9-year-old girl previously diagnosed with Angelman syndrome and high-risk T cell acute lymphoblastic leukemia who had been receiving reinduction chemotherapy, presented with pneumonia and acute respiratory distress syndrome, and progressively developed hyperferritinemic multiple-organ failure, a cytokine storm, and coagulopathy associated with COVID-19. She was treated with therapeutic plasma exchange, tocilizumab, hydrocortisone, and favipiravir, but she died 7 days after her admission into our pediatric intensive care unit.

The utility of therapeutic plasma exchange with other immunomodulatory therapies in severe presentations requires further trials. The spectrum of the inflammatory phenotypes associated with COVID-19 should be investigated and well defined to initiate the optimal treatment strategy on time.



Publication History

Received: 30 September 2020

Accepted: 05 November 2020

Publication Date:
04 January 2021 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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