Severe Sars-Cov 2 Lung Infection in a 2-Year-Old Girl Undergoing Chemotherapy for Acute Lymphoblastic Leukemia: A Case Report

ABSTRACT

BACKGROUND AND AIM: Sars-CoV-2 infection can lead to severe pulmonary impairment at all ages, however, the best therapy in children is not established. Our objective is to discuss a severe pulmonary case in a pediatric oncology patient who presented good clinical evolution and the therapeutic measures chosen in its management. METHOD(S) Case report and literature review. RESULT(S) A 2-year-old girl undergoing chemotherapy for acute lymphocytic leukemia had received cytarabine and methotrexate one week before being admitted to the ward for febrile neutropenia, identified with Sars-Cov-2 infection by RT-PCR. Referred to pediatric intensive care on day 3 of symptoms when she was prostrate and antibiotics switched to a broader spectrum. On day 8 of symptoms she rapidly developed respiratory failure and required mechanical ventilation at high parameters, CT scan showed lesions in ground glass in 75% of the lung parenchyma. On day 9, she was still feverish and showed altered inflammatory tests, such as ferritin 4492 mcg/L D-dimer 5909 ng/dL CRP 28 mg/ dL. Cardiac, hepatic and renal functions remained stable. At that moment, the patient received gammaglobulin 2g/kg in a single dose and methylprednisolone 2mg/kg/day for 5 days. Substantial improvement was observed 48 hours after the introduction of anti-inflammatory therapy, allowing for weaning and extubation after 7 days of mechanical ventilation. 72 hours after extubation, she was discharged home, breathing normally on room air. CONCLUSION(S) Severe Sars-Cov-2 lung infection in a pediatric oncology patient with markedly high inflammatory tests was treated with anti-inflammatory therapies such as steroids and gammaglobulin, with rapid and favorable recovery (Figure Presented).