Case Report: Systemic Inflammatory Response and Fast Recovery in a Pediatric Patient With COVID-19

Front Immunol. 2020 Jul 3;11:1665. doi: 10.3389/fimmu.2020.01665. eCollection 2020.

Abstract

We report a case of an 8-year-old girl who underwent a SARS-CoV-2 infection manifesting with atypical symptoms spearheaded by abdominal discomfort and systemic inflammation and partially mimicking hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS), which however did not fulfill the HLH/MAS diagnostic criteria. In this case of what has since been described as Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS) we documented excellent clinical response to immunosuppression with systemic corticosteroids and intravenous immunoglobulins. We show a detailed longitudinal development of neutrophil immunophenotype which suggests activation and engagement of neutrophils during PIMS-TS with compensatory contraction of the response and contra-regulation of neutrophil phenotype during recovery.

Keywords: COVID-19; PIMS-TS; SARS-CoV-2; hemophagocytic lymphohistiocytosis; innate immunity; macrophage activation syndrome; neutrophil; pediatric.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Betacoronavirus* / immunology
  • Betacoronavirus* / metabolism
  • COVID-19
  • Child
  • Coronavirus Infections* / blood
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / immunology
  • Female
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage*
  • Immunosuppression Therapy*
  • Inflammation / diagnosis
  • Inflammation / drug therapy
  • Inflammation / immunology
  • Lymphohistiocytosis, Hemophagocytic* / diagnosis
  • Lymphohistiocytosis, Hemophagocytic* / drug therapy
  • Lymphohistiocytosis, Hemophagocytic* / immunology
  • Macrophage Activation Syndrome* / diagnosis
  • Macrophage Activation Syndrome* / drug therapy
  • Macrophage Activation Syndrome* / immunology
  • Neutrophils
  • Pandemics*
  • Pneumonia, Viral* / blood
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / immunology
  • SARS-CoV-2

Substances

  • Adrenal Cortex Hormones
  • Immunoglobulins, Intravenous