ABSTRACT
Introduction: In 2020, coronavirus rapidly became a global pandemic leading to high mortality rates. Extensive studies done have yet to provide consistent and successful treatment options to improve disease progression and mortality. Convalescent plasma is being studied in adults with very minimal studies in the pediatric population. Here we report a case of a 16 year old with COVID-19 infection resulting in ARDS who showed drastic improvement after convalescent plasma therapy. Case Description: A 16 year old female with morbid obesity, presented to our pediatric emergency department (ED) for a 5 day history of fever, cough, congestion and respiratory distress, along with vomiting, diarrhea and diffuse abdominal pain. Patient arrived on 3 LPM (or litres/min) of oxygen, vitals stable and in no acute respiratory distress, with bilateral coarse breath sounds and diffuse abdominal pain. She tested positive on PCR test for SARSCoV-2 done via nasopharyngeal swab, otherwise unremarkable blood count and comprehensive metabolic panel. Imaging showed chest x-ray with multifocal pneumonia and an electrocardiogram was normal. She was admitted and treated Remdesivir and IV immunoglobulin (IVIG) due to the concern for multi system inflammatory syndrome in children (MIS-C). She was started on a 5 day course of low dose steroids. However, by the third day of hospitalisation, patient's respiratory status rapidly declined, eventually requiring intubation and mechanical ventilation. She was placed on Synchronised Intermittent Mandatory Ventilation (SIMV) mode, volume control with autoflow, tidal volume 550ml, requiring up to FiO2 of 80-90% and peak inspiratory pressure was ranging from 36-45. Following Mayo clinic protocol and attaining emergent FDA approval, she received Covid-19 convalescent plasma, following which she showed significant improvement in peak inspiratory pressure (ranging 20-30), within 24-36 hours of plasma therapy. Through the course of the next few days, the patient tolerated successful weaning of respiratory support and was extubated and gradually weaned to room air. She showed tremendous recovery and was discharged home. Discussion: COVID-19 infection continues to show high mortality rates. Studies show that obesity is a risk factor for severe illness as seen in case. The use of convalescent plasma along with significantly improved this patient's clinical status which is also seen on imaging. Convalescent plasma has previously been used successfully for the treatment of other viral infections including SARS-CoV, Middle East respiratory syndrome, influenza A (H1N1), and Ebola. Data from these infections also suggest that convalescent plasma is most effective when given early in the disease process. Conclusion: COVID-19 is a serious infection leading to multifocal pneumonia, ARDS and death, even in children. This case report shows the beneficial use of convalescent plasma therapy in a pediatric patient. There continues to be a need for further studies on pediatric patients on management, of which convalescent plasma is a considerable option.
ABSTRACT
Background: Hemorrhagic pericardial effusion (HPE) is an infrequently encountered entity. We present here a challenging case of HPE. Case: A 67-year-old woman with history of hypothyroidism presented with dyspnea, chest discomfort, chills since 2 weeks. She had received mRNA-1273 vaccine 7 days prior to presentation. Vitals were notable for a heart rate of 136/min, otherwise she was hemodynamically stable. Physical exam was notable for muffled heart sounds. Decision-making: Labs showed a hemoglobin of 9.6 g/dL, C reactive protien(CRP) of 93.80 mg/L, normal thyroid profile and troponin, and a negative COVID-19 PCR. ECG was suggestive of sinus tachycardia. An Echocardiogram showed ejection fraction of 55-60% and large pericardial effusion with tamponade physiology. Emergent pericardiocentesis was done, removing 940 mL of sanguineous fluid. Pericardial fluid showed predominantly red blood cells;cytology was negative for malignant cells. Infectious workup for fungal, viral, tuberculosis and bacterial infections, and antibody testing as a part of rheumatologic workup was negative. A CT of the chest, abdomen and pelvis did not show any evidence of malignancy. She remained hemodynamically stable and was discharged on colchicine and ibuprofen. The patient did well on follow up at one month. Conclusion: Despite extensive workup, underlying etiology of HPE was not identified. As the symptoms preceded vaccination, the likelihood of vaccine-induced pericarditis and HPE was deemed low. [Formula presented]