Combined course of acute respiratory coronavirus disease in a child with type 1 diabetes: a clinical case

The clinical course of coronavirus disease (COVID-19) in children in combination with diabetes mellitus is characterized by a more pronounced intensity of clinical manifestations and more frequent complications compared to patients without this premorbid condition. For unknown reasons, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may trigger new-onset diabetes. Over the last decade, the incidence of type 1 diabetes mellitus has increased and the peak age for being diagnosed with type 1 diabetes mellitus is getting younger. This article presents a clinical case of an adolescent female patient with new-onset type 1 diabetes mellitus diagnosed during hospitalization for symptomatic COVID-19 (SARS-CoV-2 was confirmed by polymerase chain reaction of naso/oropharyngeal swabs). The patient felt ill suddenly, her condition was rapidly worsening. She was hospitalized with severe acute respiratory tract infection. The blood work of the patient revealed hyperglycemia, hyperstenuria, glycosuria, ketonuria, hypertransferasemia, elevated levels of glycated hemoglobin and decreased levels of C-peptide. The patient has been receiving fluid replacement treatment intravenously, short-acting insulin to correct hyperglycemia followed by symptomatic treatment therapy. The patient responded well to the treatment plan and was discharged from the hospital after 8 days continuing treatment from home. Conclusions. The presented article describes a clinical case of COVID-19 in adolescent female patient with new-onset type 1 diabetes mellitus. The patient's severe condition was caused mainly by dehydration and COVID-19 precipitated ketoacidosis despite having light respiratory symptoms. At the moment, it is not enough data to conclude whether type 1 diabetes mellitus in pediatric population can cause serious complications from COVID-19. More studies are required to reach a definitive conclusion. © 2022 The authors.

Respiratory symptoms of COVID-19 in an adolescent patient with WHIM syndrome: a clinical case

In case of coronavirus disease 2019 (COVID-19) in children suffering from primary immunodeficiency, the last one can be an aggravating or a mitigating factor of the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. WHIM (warts, hypogammaglobulinemia, infections, and myelokathexis) syndrome is usually classified as severe congenital neutropenia, but most patients have multiple leukocyte deficits, even panleukopenia, and therefore it can also be classified as severe combined immunodeficiency. B-lymphopenia is especially severe, and this probably partly explains the hypogammaglobulinemia. This rare disease, caused by autosomal dominant mutations, is a combined variant of immunodeficiency, which includes myelokathexis, susceptibility to infections, and hypogammaglobulinemia. Myelokathexis is a unique form of acyclic severe congenital neutropenia caused by the accumulation of mature and degenerative neutrophils in the bone marrow. Monocytopenia and lymphopenia, especially B-lymphopenia, also occur. In some patients, there are defects in the development of the cardiovascular, genitourinary and nervous systems, which in general can contribute to the extremely severe course of infectious inflammatory process, in particular due to the SARS-CoV-2. Objective: to analyze the clinical and laboratory peculiarities of coronavirus disease caused by SARS-CoV-2 in immunosuppressed patients on the example of a clinical case of COVID-19 in a child with previously diagnosed WHIM syndrome. Materials and methods. The article presents our own observation of coronavirus disease in a female adolescent suffering from previously verified primary immunodeficiency (WHIM syndrome) in the period after surgical routine correction of patent ductus arteriosus. On the 2nd day of sudden disease onset, the child was hospitalized in moderate condition with signs of airway inflammation as rhinopharyngitis and obstructive bronchitis. Results. Laboratory tests showed leukopenia, absolute neutropenia, increased levels of procalcitonin, C-reactive protein, D-dimer in serum and a reduction of activated partial thromboplastin time. The treatment included hydrobalance protection per os and by infusion, systemic and topical inhalation therapy with a short steroids course, antibacterial therapy as fourth generation cephalosporins, intravenous granulocyte colony stimulating factor, and symptomatic treatment. The girl's condition became progressively better, she was discharged from the hospital on the 7th day to continue treatment at the outpatient settings. Conclusions. The severity of respiratory pathology and the prognosis of COVID-19 depend on the immunodeficiency type and compromised part of immune system, as well as the heterogeneity of new SARS-CoV-2 strains. The aggravating/protective role of primary immunodeficiency, in particular WHIM syndrome, in determining COVID-19 severity is currently limited because of small number of observations and requires further data collection. The presented clinical case describes the classic moderate coronavirus disease as airway infection in an adolescent suffering from primary immunodeficiency. © 2022. The Authors.

Guillain - Barré syndrome following asymptomatic COVID-19 in an adolescent: a clinical case

Guillain - Barré syndrome (GBS) is a rare disease that occurs with an approximate incidence of 1.7 cases per 100,000 children in the pediatric population. The gender difference in the prevalence of the disease is characterized by a 20% greater vulnerability of boys than girls. The exact cause of Guillain - Barre syndrome is unknown;however, it can occur after respiratory infection by Haemophilus influenzae, recent or ongoing Campylobacter jejuni infection or poliovirus. Since the beginning of the COVID-19 pandemic, there have been some reported Guillain - Barré diagnoses among adults following SARS-CoV-2 infection. The article describes a clinical case of an adolescent girl who was admitted to the Regional Municipal Non-Profit Facility “Chernivtsi Regional Children's Clinical Hospital” with signs of flaccid paraplegia of the lower extremities, pelvic dysfunction and paraparesis of the upper extremities after she had suffered a sudden severe pain syndrome. She had previously been diagnosed with asymptomatic SARS-CoV-2. Initial complex investigations were as follows: high white blood cells count, elevated levels of procalcitonin (PCT), C-reactive protein and D-dimer, low SARS-CoV-2 IgM level and positive IgG titer, high levels of protein in spinal fluid. Electroneuromyography findings and nerve conduction test of lower extremities showed decreased M amplitude and H reflex response. The patient received oxygen therapy, hemodynamic support, cardiac support (infusions and inotrope therapy), gradual antibacterial therapy and was administrated with intravenous normal human immunoglobulin. She was also treated with a short course of parenteral glucocorticoids, vasoactive neurometabolites, nootropics, anticholinesterases, non-steroidal anti-inflammatory drugs along with physical therapy and massages. The patient began demonstrating slow but positive improvement in her limb motor functions and sensitivity within one month. © 2022. The Authors.