A Pediatric COVID-19 Case suspected with different types of
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A healthy 12/y/old female patient had been admitted with abdominal pain, vomiting and fever and hospitalized with a pre-diagnosis of acute appendicitis. Surgical intervention decision was abandoned in the patient whose diarrhea started. SARS CoV2 RT-PCR test was positive. Abdominal CT revealed multiple lymphadenopathies with an edematous appearance compatible with typhlitis in terminal ileum. Broad-spectrum antibiotics and antiviral therapies were administered.

COVID-19-associated MIS-C was considered in the patient. Because the patient’s fever was above 38 °C and was resistant to antipyretics, there was no decrease in infectious parameters, lymphopenia did not improve, albumin level did not increase despite albumin replacement, and respiratory and gastrointestinal symptoms continued. IVIG 2 g/kg was administered as a 12-h infusion. The patient’s fever decreased dramatically after IVIG infectious parameters regressed. Pancreatitis developed on the 4th day. The patient was discharged on the 13th day.

In a pediatric series, all 8 cases presented with atypical appendicitis. Radiological imaging revealed lymphadenopathy in the abdomen and terminal ileitis in all children. Three of them required inotropic support in PICU. Four patients suspected of MIS-C were given IVIG. In India, an 11-y-old patient presented with fever, abdominal pain and skin rash. Radiological imaging revealed inflammation in the terminal ileum and cecum. SARS CoV2 RT-PCR test was positive, and clinical improvement was observed with IVIG treatment.

Elevated ferritin levels were associated with increased mortality in COVID-19 patients. Management of hyperferritinemic sepsis can differ from sepsis without hyperferritinemia. In addition to the usual antimicrobial approach, one should consider administration of specific antivirals, antiparasitics, antibacterials, and antifungals; as well as non-specific neutralization with IVIG for infections without specific therapies in the hyperferritinemic patient.

Although it is not clear whether pancreatitis in this case was related to drugs or developed as a part of the gastrointestinal presentation of COVID-19. This case is important in terms of drawing attention that COVID-19 may present with a picture that mimics acute appendicitis in children.

Source: https://link.springer.com/article/10.1007/s12098-020-03544-0
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