CASE 3
A 17-year-old-boy with a sensorineural hearing loss and no chronic
systemic illness admitted to a hospital with a 7-day history of fever,
abdominal pain and vomiting. Lumbar puncture was performed due to severe
headache and CSF findings were normal. Later on, he had respiratory
distress, hypotension and admitted to ICU. Diminished left ventricular
function (EF:33%) was present. Bilateral consolidations compatible with
COVID-19 pneumonia and pleural effusion were reported in the thoracic
computed tomography (CT). He had a history of contact with a relative
who had COVID-19 three weeks ago. During 10-day hospitalization
SARS-CoV-2 RT-PCR was negative for three times. He was referred to our
hospital for potential extracorporeal membrane oxygenation (ECMO)
requirement. On admission he was intubated and had invasive respiratory
support. He had 38.3°C fever with tachycardia (146/min). He was
hypotensive and started on inotropic treatment. He had edema on the
extremities, hepatomegaly and diminished respiratory sounds.
Marked laboratory findings are given in Table 1. Notably elevated
cardiac enzymes were present; BNP was 5704 pg/mL, troponin 5927 ng/L,
CK-MB 11.8 µg/L, myoglobin 559 µg/L. Left ventricular hypertropia and
minimal pericardial effusion were reported on echocardiography (EF:
45%).
His SARS-CoV-2 RT-PCR was negative and SARS-CoV-2 IgG was positive; 8.9.
Plasma exchange applied. He was started on plasma exchange, IVIg,
steroid, anakinra, enoxaparin and antibiotics (ceftriaxone, teicoplanin
and clarithromycin). Bone marrow aspiration revealed hemophagocytosis
and increased number of free histiocytes (Figure 2 E&F). After
two-month hospital stay, he was discharged very well.