Fatal COVID-19 in a Child with Persistence of SARS-CoV-2 Despite Extensive Multidisciplinary Treatment: A Case Report
Sofia Apostolidou,
Theresa Harbauer,
Peter Lasch,
Daniel Biermann,
Maja Hempel,
Marc Lütgehetmann,
Susanne Pfefferle,
Jochen Herrmann,
André Rüffer,
Konrad Reinshagen,
Rainer Kozlik-Feldmann,
Anna Gieras,
Inga Kniep,
Jun Oh,
Dominique Singer,
Chinedu Ulrich Ebenebe,
Robin Kobbe
Affiliations
Sofia Apostolidou
Division of Neonatology and Pediatric Critical Care Medicine, University Children’s Hospital, University Medical Center Eppendorf, 20246 Hamburg, Germany
Theresa Harbauer
Division of Neonatology and Pediatric Critical Care Medicine, University Children’s Hospital, University Medical Center Eppendorf, 20246 Hamburg, Germany
Peter Lasch
Pediatric Intensive Care Medicine, Department of Pediatrics, Clinic Bremen-Mitte, Bremen Hospital Group, 28205 Bremen, Germany
Daniel Biermann
Departments of Pediatric Cardiology and Pediatric Cardiac Surgery, Clinic for Children’s Heart Medicine, University Heart and Vascular Center Hamburg, 20246 Hamburg, Germany
Maja Hempel
Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Marc Lütgehetmann
Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Susanne Pfefferle
Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Jochen Herrmann
Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
André Rüffer
Departments of Pediatric Cardiology and Pediatric Cardiac Surgery, Clinic for Children’s Heart Medicine, University Heart and Vascular Center Hamburg, 20246 Hamburg, Germany
Konrad Reinshagen
Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Rainer Kozlik-Feldmann
Departments of Pediatric Cardiology and Pediatric Cardiac Surgery, Clinic for Children’s Heart Medicine, University Heart and Vascular Center Hamburg, 20246 Hamburg, Germany
Anna Gieras
Department of Immunology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Inga Kniep
Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
Jun Oh
Department of Pediatric Nephrology, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Dominique Singer
Division of Neonatology and Pediatric Critical Care Medicine, University Children’s Hospital, University Medical Center Eppendorf, 20246 Hamburg, Germany
Chinedu Ulrich Ebenebe
Division of Neonatology and Pediatric Critical Care Medicine, University Children’s Hospital, University Medical Center Eppendorf, 20246 Hamburg, Germany
Robin Kobbe
First Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Critical Coronavirus disease 2019 (COVID-19) developed in a 7-year-old girl with a history of dystrophy, microcephaly, and central hypothyroidism. Starting with gastrointestinal symptoms, the patient developed severe myocarditis followed by progressive multiple organ failure complicated by Pseudomonas aeruginosa bloodstream infection. Intensive care treatment consisting of invasive ventilation, drainage of pleural effusion, and high catecholamine therapy could not prevent the progression of heart failure, leading to the implantation of venoarterial extracorporeal life support (VA-ECLS) and additional left ventricle support catheter (Impella® pump). Continuous venovenous hemofiltration (CVVH) and extracorporeal hemadsorption therapy (CytoSorb®) were initiated. Whole exome sequencing revealed a mutation of unknown significance in DExH-BOX helicase 30 (DHX30), a gene encoding a RNA helicase. COVID-19 specific antiviral and immunomodulatory treatment did not lead to viral clearance or control of hyperinflammation resulting in the patient’s death on extracorporeal life support-(ECLS)-day 20. This fatal case illustrates the potential severity of pediatric COVID-19 and suggests further evaluation of antiviral treatment strategies and vaccination programs for children.
