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Arch Dis Child ; 106(11): 1129-1132, 2021 11.
Article in English | MEDLINE | ID: covidwho-1209813


Knowledge of thrombosis in children with SARS-CoV-2 is scarce. In this multicentre national cohort of children with SARS-CoV-2 involving 49 hospitals, 4 patients out of 537 infected children developed a thrombotic complication (prevalence of 0.7% (95% CI: 0.2% to 1.9%) out of the global cohort and 1.1% (95% CI: 0.3% to 2.8%) out of the hospitalised patients). We describe their characteristics and review other published paediatric cases. Three out of the four patients were adolescent girls, and only two cases had significant thrombotic risk factors. In this paediatric cohort, D-dimer value was not specific enough to predict thrombotic complications. Adolescence and previous thrombotic risk factors may be considered when initiating anticoagulant prophylaxis on children with SARS-CoV-2 disease (COVID-19).

COVID-19/complications , SARS-CoV-2 , Thrombosis/epidemiology , Adolescent , Adult , COVID-19/epidemiology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Prevalence , Prospective Studies , Risk Factors , Spain/epidemiology , Thrombosis/etiology , Young Adult
Mod Rheumatol Case Rep ; 5(1): 101-107, 2021 01.
Article in English | MEDLINE | ID: covidwho-917630


Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis (anti-MDA5 JDM) is associated with high risk of developing rapidly progressive interstitial lung disease (RP-ILD). Here we report an 11-year-old girl with anti-MDA5 JDM and RP-ILD which led to a fatal outcome, further aggravated by SARS-CoV-2 infection. She was referred to our hospital after being diagnosed with anti-MDA5 JDM and respiratory failure due to RP-ILD. On admission, fibrobronchoscopy with bronchoalveolar lavage (BAL) revealed Pneumocystis jirovecii infection so treatment with intravenous trimethoprim-sulfamethoxazole was initiated. Due to RP-ILD worsening, immunosuppressive therapy was intensified using methylprednisolone pulses, cyclophosphamide, tofacitinib and intravenous immunoglobulin without response. She developed severe hypoxemic respiratory failure, pneumomediastinum and pneumothorax, further complicated with severe RP-ILD and cervical subcutaneous emphysema. Three real-time RT-PCR for SARS-CoV-2 were made with a negative result. In addition, she was complicated with a secondary hemophagocytic lymphohistiocytosis and a fourth real-time PCR for SARS-CoV-2 performed in BAS sample was positive. Despite aggressive treatment of RP-ILD due to anti-MDA5 JDM, there was no improvement of respiratory failure in the following days and patient developed refractory septic shock and died. Anti-MDA5 JDM patients with RP-ILD have a poor prognosis with a high mortality rate. For this reason, intensive immunosuppressive therapy is essential including the use of promising drugs such as tofacitinib. COVID-19 in children with underlying health conditions like anti-MDA5 JDM may still be at risk for disease and severe complications.

COVID-19/complications , Dermatomyositis/complications , Immunosuppressive Agents/therapeutic use , Lung Diseases, Interstitial/complications , Lymphohistiocytosis, Hemophagocytic/etiology , Pneumonia, Pneumocystis/complications , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Autoantibodies/immunology , Bronchoscopy , COVID-19/therapy , COVID-19 Nucleic Acid Testing , Child , Cyclophosphamide/therapeutic use , Dermatomyositis/drug therapy , Dermatomyositis/immunology , Disease Progression , Fatal Outcome , Female , Humans , Hydroxychloroquine/therapeutic use , Immunocompromised Host , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferon-Induced Helicase, IFIH1/immunology , Lung/diagnostic imaging , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/immunology , Lung Diseases, Interstitial/therapy , Lymphohistiocytosis, Hemophagocytic/immunology , Mediastinal Emphysema/etiology , Methylprednisolone/therapeutic use , Piperidines/therapeutic use , Pneumonia, Pneumocystis/immunology , Pneumothorax/etiology , Pyrimidines/therapeutic use , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Shock, Septic/etiology , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use