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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
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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.

Keywords

acute lymphoblastic leukemia - coronavirus disease 2019 (COVID-19) - critically ill children - hyperferritinemia - therapeutic plasma exchange


Publikationsverlauf

Eingereicht: 30. September 2020

Angenommen: 05. November 2020

Artikel online veröffentlicht:
04. Januar 2021

© 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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Wang Y, Zhu F, Wang C. et al. Children hospitalized with severe COVID-19 in Wuhan. Pediatr Infect Dis J 2020; 39 (07) e91-e94
    CrossrefPubMedGoogle Scholar
  • 2 Zachariah P, Johnson CL, Halabi KC. et al; Columbia Pediatric COVID-19 Management Group. Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a Children's Hospital in New York City, New York. [published online ahead of print, 2020 Jun 3] JAMA Pediatr 2020; 174 (10) e202430
    CrossrefPubMedGoogle Scholar
  • 3 Shekerdemian LS, Mahmood NR, Wolfe KK. et al; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian Pediatric Intensive Care Units. [published online ahead of print, 2020 May 11] JAMA Pediatr 2020; 174 (09) 868-873
    CrossrefPubMedGoogle Scholar
  • 4 DeBiasi RL, Song X, Delaney M. et al. Severe coronavirus disease-2019 in children and young adults in the Washington, DC, metropolitan region. J Pediatr 2020; 223: 199-203.e1
    CrossrefPubMedGoogle Scholar
  • 5 Chao JY, Derespina KR, Herold BC. et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a Tertiary Care Medical Center in New York City. J Pediatr 2020; 223: 14-19.e2
    CrossrefPubMedGoogle Scholar
  • 6 Hoang A, Chorath K, Moreira A. et al. COVID-19 in 7780 pediatric patients: a systematic review. EClinicalMedicine 2020; 24: 100433 DOI: 10.1016/j.eclinm.2020.100433.
    CrossrefPubMedGoogle Scholar
  • 7 Godfred-Cato S, Bryant B, Leung J. et al; California MIS-C Response Team. COVID-19-associated multisystem inflammatory syndrome in children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (32) 1074-1080
    CrossrefPubMedGoogle Scholar
  • 8 REPUBLİC OF TURKEY MINISTRY OF HEALTH, COVID-19 Situation Report. Accessed September 2, 2020 at: https://sbsgm.saglik.gov.tr/TR,68773/covid-19-situation-report-turkey-eng.html
    PubMed
  • 9 Diorio C, Henrickson SE, Vella LA. et al. Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2. [published online ahead of print] J Clin Invest 2020; 130 (11) 5967-5975
    CrossrefPubMedGoogle Scholar
  • 10 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. [published correction appears in Intensive Care Med. 2020 Apr 6;] Intensive Care Med 2020; 46 (05) 846-848
    CrossrefPubMedGoogle Scholar
  • 11 Wu C, Chen X, Cai Y. et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180 (07) 934-943
    CrossrefPubMedGoogle Scholar
  • 12 Bonetti G, Manelli F, Patroni A. et al. Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy. Clin Chem Lab Med 2020; 58 (07) 1100-1105
    CrossrefPubMedGoogle Scholar
  • 13 Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol 2020; 7 (06) e438-e440
    CrossrefPubMedGoogle Scholar
  • 14 Latimer G, Corriveau C, DeBiasi RL. et al. Cardiac dysfunction and thrombocytopenia-associated multiple organ failure inflammation phenotype in a severe paediatric case of COVID-19. Lancet Child Adolesc Health 2020; 4 (07) 552-554
    CrossrefPubMedGoogle Scholar
  • 15 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395 (10229): 1033-1034
    CrossrefPubMedGoogle Scholar
  • 16 Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care 2020; 24 (01) 360 DOI: 10.1186/s13054-020-03077-0.
    CrossrefPubMedGoogle Scholar
  • 17 Liu B, Li M, Zhou Z, Guan X, Xiang Y. Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)?. J Autoimmun 2020; 111: 102452 DOI: 10.1016/j.jaut.2020.102452.
    CrossrefPubMedGoogle Scholar
  • 18 Bennett TD, Hayward KN, Farris RW, Ringold S, Wallace CA, Brogan TV. Very high serum ferritin levels are associated with increased mortality and critical care in pediatric patients. Pediatr Crit Care Med 2011; 12 (06) e233-e236
    CrossrefPubMedGoogle Scholar
  • 19 Nguyen TC, Carcillo JA. Bench-to-bedside review: thrombocytopenia-associated multiple organ failure--a newly appreciated syndrome in the critically ill. Crit Care 2006; 10 (06) 235 DOI: 10.1186/cc5064.
    CrossrefPubMedGoogle Scholar
  • 20 COVID-19 Treatment Guidelines Panel, Coronavirus Disease. 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. . Accessed September 2, 2020 at: https://www.covid19treatmentguidelines.nih.gov/
    PubMedGoogle Scholar
  • 21 Demirkol D, Yildizdas D, Bayrakci B. et al; Turkish Secondary HLH/MAS Critical Care Study Group. Hyperferritinemia in the critically ill child with secondary hemophagocytic lymphohistiocytosis/sepsis/multiple organ dysfunction syndrome/macrophage activation syndrome: what is the treatment?. Crit Care 2012; 16 (02) R52
    CrossrefPubMedGoogle Scholar
  • 22 Demirkol D, Carcillo J. Management of the critically ill child with the sepsis/hemophagocytic lymphohistiocytosis/macrophage activation syndrome overlap syndrome. J Pediatr Intensive Care 2014; 3 (04) 243-254
    PubMedGoogle Scholar
  • 23 Rosário C, Zandman-Goddard G, Meyron-Holtz EG, D'Cruz DP, Shoenfeld Y. The hyperferritinemic syndrome: macrophage activation syndrome, Still's disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med 2013; 11: 185
    CrossrefPubMedGoogle Scholar
  • 24 Fortenberry JD, Nguyen T, Grunwell JR. et al; Thrombocytopenia-Associated Multiple Organ Failure (TAMOF) Network Study Group. Therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure: the thrombocytopenia-associated multiple organ failure network prospective experience. Crit Care Med 2019; 47 (03) e173-e181
    CrossrefPubMedGoogle Scholar
  • 25 Sevketoglu E, Yildizdas D, Horoz OO. et al. Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure network. Pediatr Crit Care Med 2014; 15 (08) e354-e359
    CrossrefPubMedGoogle Scholar
  • 26 Patel P, Nandwani V, Vanchiere J, Conrad SA, Scott LK. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A--an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med 2011; 12 (02) e87-e89
    CrossrefPubMedGoogle Scholar
  • 27 Keith PD, Wells AH, Hodges J, Fast SH, Adams A, Scott LK. The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience. Crit Care 2020; 24 (01) 518
    CrossrefPubMedGoogle Scholar
  • 28 Morath C, Weigand MA, Zeier M, Speer C, Tiwari-Heckler S, Merle U. Plasma exchange in critically ill COVID-19 patients. Crit Care 2020; 24 (01) 481
    CrossrefPubMedGoogle Scholar
  • 29 Gucyetmez B, Atalan HK, Sertdemir I, Cakir U, Telci L. COVID-19 Study Group. Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study. Crit Care 2020; 24 (01) 492
    CrossrefPubMedGoogle Scholar
  • 30 Fardet L, Galicier L, Lambotte O. et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol 2014; 66 (09) 2613-2620
    CrossrefPubMedGoogle Scholar