Case Report: Hyperinflammatory Status in an Immunocompromised Child With a Highly Sustained Viral Load of SARS-CoV-2

Abstract

Coronavirus disease 2019 (COVID-19) is spreading throughout the world. Limited data are available for the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (VL) in immunocompromised pediatric patients. Here, we report the clinical characteristics and the dynamics of SARS-CoV-2 VL of a pediatric patient with acute myeloid leukemia who developed a hyperinflammatory status mimicked MIS-C. The clinical course was characterized by the late onset of fever, GI symptoms, rash, and respiratory distress, including oxygen requirement with sustained VL of SARS-CoV-2 around 7 log₁₀ RNA copies/mL for 6 weeks. It is important to note that the hyperinflammatory status developed early at the third week of hospitalization-in a context of high VL and immunocompromised status. All these characteristics make this clinical case unique. On the other hand, while many reports have characterized the dynamics of SARS-CoV-2 VL in adults and immunocompetent hosts, it remains unreported in pediatrics-even less in immunosuppressed children.

Keywords: COVID-19; SARS-CoV-2; hyperinflammatory status; immunocompromised state; pediatrics; viral load.

Figure 1

Dynamic of SARS-CoV-2 since admission. Dashed lines in gray, blue, and red represent the limit of quantification value, gamma globulin treatment, and convalescent plasma treatment, respectively, whereas the green bar represents the days under corticosteroids therapy. The bars below the VL curve show the period in which the child stayed in the intermediate care unit (IMCU) and intensive care unit (ICU).