COVID-19 in Combination with HLH in a Child with Severe Aplastic Anemia

Abstract

Since December 2019, the coronavirus (COVID-19) has spread all over the world. This disease may present differently in immune-compromised persons. Some of the virus's impacts have yet to be identified. In this case report, we report a three-year-and-three-month-old child with aplastic anemia who was concurrently infected with COVID-19 and HLH (hemophagocytic lymphohistiocytosis). She was referred to our center for further investigation of aplastic anemia with concurrent fever. Through examination due to splenomegaly, more evaluations were done. During admission, the PCR test for COVID-19 became positive, however, because of the fulfillment of the HLH criteria, she was diagnosed with this disease development. She was treated for HLH with IVIG and Dexamethasone while getting COVID-19 treatment. Following medicines and follow-up, her WBC and Hb count started to rise, aside from the PLT count. She continues to receive PLTs because of her thrombocytopenia till a suitable donor for BMT (Bone Marrow Transplant) is found. This case scenario highlights the COVID-19 concurrent complications for paying attention to underlying disease for better diagnosis and management.

Keywords:

COVID-19, pediatrics, pancytopenia, aplastic anemia

References
[1] Adel, M. and Magdy, A. (2021). SARS-CoV-2 infection in an infant with non-respiratory manifestations: A case report. Egyptian Pediatric Association Gazette, vol. 69, no. 1, p. 3.

[2] Deville, J. G., Song, E., and Ouellette, C. P. (2021). COVID-19: Clinical manifestations and diagnosis in children. UpToDate.

[3] Akçabelen, Y., Yozgat, A. K., Ozkaya-Parlakay, A., et al. (2020). COVID-19 in a child with severe aplastic anemia. Authorea Preprints.

[4] Mostafavi, S. N., Sadeghizadeh, A., Babaei, S., et al. (2020). Successful recovery of a child with COVID-19-induced secondary hemophagocytic lymphohistiocytosis. Archives of Pediatric Infectious Diseases, vol. 10, no. 1, p. e111434.

[5] Arceci, R. J. (2016). Histiocytosis syndromes. Lanzkowsky's manual of pediatric hematology and oncology (pp. 407–428). Elsevier.

[6] Brodin, P. (2020). Why is COVID-19 so mild in children? Acta Paediatrica, vol. 109, no. 6, pp. 1082–1083.

[7] Cyranoski, D. (2020). Why children avoid the worst coronavirus complications might lie in their arteries. Nature, vol. 582, no. 7812, pp. 324–325.

[8] Zimmermann, P. and Curtis, N. (2021). Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections. Archives of Disease in Childhood, vol. 106, no. 5, pp. 429–439.

[9] Bunyavanich, S., Do, A., and Vicencio, A. (2020). Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA, vol. 323, no. 23, pp. 2427–2429.

[10] Hyde, Z. (2021). Difference in SARS-CoV-2 attack rate between children and adults may reflect bias. Clinical Infectious Diseases, vol. 74, no. 1, pp. 152–155.

[11] Boulad, F., Kamboj, M., Bouvier, N., et al. (2020). COVID-19 in children with cancer in New York City. JAMA Oncology, vol. 6, no. 9, pp. 1459–1460.

[12] Marlais, M., Wlodkowski, T., Vivarelli, M., et al. (2020). The severity of COVID-19 in children on immunosuppressive medication. The Lancet Child & Adolescent Health, vol. 4, no. 7, pp. e17–e18.

[13] Turner, D., Huang, Y., Martín-de-Carpi, J., et al. (2020). Corona virus disease 2019 and paediatric inflammatory bowel diseases: Global experience and provisional guidance (March 2020) from the Paediatric IBD Porto Group of European Society of Paediatric Gastroenterology, Hepatology, and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, vol. 70, no. 6, pp. 727–733.

[14] Filocamo, G., Minoia, F., Carbogno, S., et al. (2021). Absence of severe complications from SARS-CoV-2 infection in children with rheumatic diseases treated with biologic drugs. Journal of Rheumatology, vol. 48, no. 8, pp. 1343–1344.