COVID-19 Case Complicated by Shock and Spontaneous Pneumothorax in an Infant

Abstract

Introduction. The spread of SARS-CoV-2 Delta variant was accompanied by coronavirus disease incidence increase in children. In addition to an increase in the number of pediatric patients, cases of complicated COVID-19 are more common, particularly in infants. The study’s objective is improving doctors' awareness of possible complications of coronavirus disease in children. Methods. We analyzed a case of coronavirus infection complicated by shock and spontaneous pneumothorax in an infant hospitalized at Kyiv City Children’s Clinical Infectious Diseases Hospital in 2021. Results. The 4-month-old baby had no significant health issues before this episode. The child got sick with the onset of moderate fever, symptoms of upper respiratory tract lesions. Infant was observed by a family doctor from the first day of illness and received symptomatic treatment. On the second day of illness, the child’s condition suddenly deteriorated. Heavy breathing appeared and cough intensified. SpO2 – 90%, respiratory rate – 40/min., expiratory dyspnea, when hospitalized. PCR test positive for SARS-CoV-2, Deltastrain. Non-invasive ventilation, remdesevir, corticosteroids and anticoagulants were prescribed according to the current protocol based on WHO and CDC recommendations. On the 4th day of the disease the condition worsened due to refractory shock, multiorgan failure. Antishock therapy (volemic support, sympathomimetics) was administered, transferred to artificial lung ventilation. Against the background of unstable hemodynamics on the 9th day, a rapid deterioration of respiratory function occurred: tachypnea up to 72 per minute, decreased saturation up to 82-86%. Ultrasound and X-ray diagnostics confirmed the presence of right-sided tension pneumothorax. Drainage of the pleural cavity was performed, followed by X-ray control. From the 9th to the 15th day of illness, the child’s condition remained severe due to unstable hemocirculation and respiratory disorders. From the 16th day there was a positive trend with full recovery on the 30th day of illness. Final diagnosis: 2019-nCoV acute respiratory disease COVID-19 (Delta). Community-acquired bilateral pneumonia. Septic shock. Right-sided pneumothorax. Brain edema. Severe anemia. Conclusions. Coronavirus disease may be complicated by shock and spontaneous pneumothoraxin infants. SARS-CoV-2 Delta strain disease was characterized by early development of complications and a long recovery period. Awareness of such complications will help improve the effectiveness of treatment of children with COVID-19.