Case reports
Case 1 : A term-born boy with unremarkable history was
admitted to the emergency department with
poorly tolerated high fever
(38.8°C) and rhinitis. The parents, who had no history of asthma or
allergy, showed clinical signs suggesting SARS-CoV-2 infection. RT-PCR
for SARS-CoV-2 on a nasopharyngeal swab was positive for the father and
the grandfather, who was hospitalized in the intensive care unit.
Neurologic examination of the infant revealed lethargy and hypotonia
with a bulging anterior fontanelle. The respiratory condition and
clinical examination findings including hemodynamics were normal.The
first blood test showed isolated lymphopenia (lymphocyte count 1.56
x109/L; normally 4-6x109/L) without
modification of biological inflammatory parameters, as assessed by
normal levels of C-reactive protein (CRP) and procalcitonin (PCT).
Spinal fluid analysis, cytobacteriological urine analysis and blood
culture were negative. RT-PCR of a nasopharyngeal swab was positive for
SARS-CoV-2 but negative for respiratory syncytial virus (RSV) and
influenza virus (IV). The patient received fluid volume expansion(20
ml/Kg of 0.9% sodium chloride solution) together with antibiotic
treatment (cefotaxime, amoxicillin and gentamicin at meningeal doses)
for 24 hr, that was stopped with a positive RT-PCR test for SARS-CoV-2
and negative blood culture. Favourable clinical outcome was obtained
shortly thereafter, allowing the infant to return home 2 days later.
Ten days later, the child returned with acute bronchiolitis. Respiratory
symptoms included polypnea, shortness of breath, wheezing and hypoxia
(SpO2< 92 %). Lung ultrasonography revealed signs of
interstitial syndrome with thickened and irregular pleural line
associated with confluent B lines and small multifocal subpleural
consolidations. RT-PCR for RSV and IV remained negative. Treatment
associated supplemental oxygen and enteral nutrition for 6 days. A
second episode of acute bronchiolitis occurred 1 month later, but a
RT-PCR test for SARS-CoV-2 was negative. The chest X-ray was normal. The
child remained hospitalized for 5 days with enteral nutrition support
but did not require oxygen supplementation. Long-term treatment with
inhaled daily corticosteroids (fluticasone) was introduced.
Case 2 : A term-born eutrophic male with otherwise
unremarkable neonatal history was referred for poorly tolerated high
fever at age 2 months. Both parents had clinical signs of COVID-19 but
were not tested (a member of the family had a positive test). The
neurologic examination revealed lethargia and hypotonia in the child;
the respiratory condition and clinical examination findings including
hemodynamics were normal. The first blood test showed lymphopenia
(lymphocyte count: 1.86 x109/L; normally
4-6x109/L)without modification of biological
inflammatory parameters. Cytobacteriological examination of urine and
blood culture were negative and spinal fluid analysis was not performed.
RT-PCR testing of a nasopharyngeal swab was positive for SARS-CoV-2 but
negative for RSV and IV. The patient did not receive any antibiotics. On
day 3 after admission, the respiratory condition progressively worsened,
with retraction, wheezing, increased respiratory rate at 80/min and
hypoxia (SpO2 < 92%) requiring supplemental oxygen together
with enteral nutrition for 3 days. The chest X-ray was normal, and no
lung ultrasonography was performed. The infant was returned to the
emergency department 2 weeks later with a non-severe wheezing episode
and was discharged at home.