Acute COVID-19 Infection in a Pediatric Patient with ROHHAD

Abstract

The novel coronavirus (severe acute respiratory syndrome coronavirus-2) has led to a global pandemic. In the adult population, coronavirus disease 2019 (COVID-19) has been found to cause multiorgan system damage with predicted long-term sequelae. We present a case of a 10-year-old boy with a history of ROHHAD (rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation) who presented with hypoxia, emesis, and abdominal pain. Imaging found bilateral ground glass opacities in the lungs and a pericardial effusion. Laboratory evaluation was concerning for elevated inflammatory markers. Remdesivir, hydroxychloroquine, and anticoagulation (heparin and enoxaparin) were utilized. The patient's severe respiratory failure was managed with conventional mechanical ventilation, inhaled nitric oxide, and airway pressure release ventilation. We hope that this report provides insight into the course and management of the severe acute pediatric COVID-19 patient, specifically with underlying comorbidities such as ROHHAD. Clinical trial registration is none.

Keywords: COVID-19; ROHHAD; inflammatory syndrome.

Fig. 1

Computed tomography of the chest demonstrating ground glass opacities, pericardial effusion.

Fig. 2

Chest X-ray demonstrating alveolar and interstitial pulmonary edemas.

Fig. 3

Trends and treatments throughout hospital course. All dates that have no lab value correspond to the sample not being drawn that day at the clinician's direction. CRP, C-reactive protein; DDAVP, D-amino D-arginine vasopressin; HFNC, high-flow nasal cannula; iNO, inhaled nitric oxide; IV, intravenous.