Tehran University Medical Journal (Mar 2023)
A rare complication of covid-19 infection in a 14-month-old infant: a case report
Abstract
Background: Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in some patients leads to cytokine storm and causes hemophagocytic lymphohistiocytosis (HLH) secondary to this viral agent. HLH is a rare and aggressive disease that increases in children, and is caused by changes in the immune system that associated with high mortality. Consideing the current pandemic, early diagnosis and treatment is important. Herein, we report a case of a 14-month-old infant presented with COVID-19 and prolonged fever who was eventually treated with the diagnosis of HLH. The study has been done in Sanandaj in January 2020. Case Presentation: A 14-month-old female infant with Covid-19, in November 2019 with prolonged fever lasting for 12 days, weakness and lethargy was admitted to Sanandaj Social Security Hospital, in November 2019. The infant did not have any history of illness, drug or allergy and had received vaccination according to the country's protocol. Later she was transferred to Besat Hospital in Sanandaj due to persistent fever and elevated liver enzymes. The patient had severe leukocytosis and hepatosplenomegaly in the second center. During the diagnostic measures for the patient and the rule out of other possible causes through imaging and laboratory investigations and also the evaluation of relevant criteria, HLH was suggested and treated with antibiotics (ceftriaxone, meropenem), IVIg, dexamethasone and pantoprazole. After that the fever decreased, then oral prednisolone was prescribed and a follow-up was recommended. She was discharged in good general condition. Conclusion: The current Covid-19 pandemic causes infection of children and may lead to occurrence of secondary HLH disease. therefore, assessment of children with liver manifestations and resistant fever should be considered by performing a PCR test to avoid complications and consequences as much as possible by timely treatment. more studies should be done in the field of its various dimensions.
