Infant With SARS-CoV-2 Infection Causing Severe Lung Disease
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An ex-premature infant presenting with severe acute respiratory syndrome coronavirus 2 infection in the fifth week of life reported. This case highlights that infection can be associated with life-threatening pulmonary disease in young infants and that infection can follow a similar disease course to that described in adults. A data is provided on the use of the novel antiviral remdesivir in a young child.

The clinical course differs from other reported pediatric cases showing only mild respiratory system involvement. Although his condition initially improved, severe acute respiratory distress syndrome (ARDS) developed at the time prophylactic steroids were given to prepare for extubation. Progressive hypoxia led to several failed attempts at intubation. Nasopharyngeal aspirate SARS-CoV-2 RNA polymerase chain reaction (PCR) result was positive. He was successfully intubated in theater via microlaryngobronchoscopy. Significant glottic swelling and copious airway secretions were noted. An initial chest radiograph revealed mild bilateral ground-glass opacities. C-reactive protein was 42 mg/L, and the patient was lymphopenic (1.45 × 109/L) with an otherwise normal blood picture. A line-associated femoral arterial thrombus was treated with therapeutic anticoagulation.

An intravenous loading dose of 5 mg/kg remdesivir was given, followed by 1.25 mg/kg maintenance dose for 10 days. Interleukin 10 was raised (110 pg/mL) but normalized by day 5 of treatment. C-reactive protein peaked at 63 mg/L on day 6, ferritin 789 ?g/L on day 9, and D-dimer 1143 ?g/L on day 10. Initially positive SARS-CoV-2 RNA PCR tracheal aspirates became negative after 5 days of treatment with remdesivir, excluding an isolated positive result on day 10 of remdesivir. No drug toxicity was observed.

This case highlights a positive outcome for a critically unwell infant with SARS-CoV-2 infection. The infant tolerated remdesivir treatment without complication and was discharged from the hospital. High-frequency oscillatory ventilation, nitric oxide, and intermittent prone positioning were then required, and after the use of the antiviral agent remdesivir, he made a full recovery before being discharged from the hospital.