Case Description
A 17-year-old female with a history of trisomy 21, aortic insufficiency, celiac disease, and obesity was admitted to our institution as a transfer from an outside emergency department with dehydration, fever, diarrhea, and a recent, known household member positive for SARS-CoV-2. Prior to admission, the patient experienced five days of fever, lethargy, mucopurulent nasal secretions, decreased oral intake, and decreased urine output. The patient’s vital signs were normal at time of admission. Laboratory evaluation revealed leukopenia (900/uL), thrombocytopenia (98,000/uL), and severe neutropenia (0.351 X 109/L neutrophils). No morphological abnormalities were observed on the peripheral blood smear. Chest radiography revealed findings compatible with bilateral pneumonia visualized in the lower lung fields. The patient was placed on empiric antibiotics secondary to severe neutropenia.
Over the course of the next 24 hours, the patient’s nasopharyngeal swab was reported positive for COVID-19. She developed hypoxemia requiring escalation of care to our pediatric intensive care unit and high flow oxygen therapy was initiated. The patient was treated with corticosteroids and an antiviral (remdesivir) given worsening clinical status according to institutional guidelines and in consultation with pediatric infectious disease. The patient underwent further laboratory evaluation for multisystem inflammatory syndrome (MIS-C), with findings of mildly elevated D-Dimer level (0.87 mcg/mL) and hypoalbuminemia (2.7 mg/dL). Otherwise, no additional laboratory abnormalities were noted.
Throughout the course of her hospital stay, the patient’s hematological manifestations improved with uptrend of her white blood count (1400/uL), platelet count (132,000/uL), and absolute neutrophil count (0.798 X109/L neutrophils) without clinical complications. The patient was transferred to the general pediatrics floor on day five of hospitalization, weaning off oxygen support. She was subsequently discharged on day six of hospitalization after tolerating room air without further hypoxemia. The patient followed up with her pediatrician one month later and repeat laboratory evaluation revealed normal white blood count, platelet count, and absolute neutrophil count.