A 2-year-old, otherwise healthy boy with a history of COVID-19-positive patient contact was hospitalized with nausea, vomiting, and poor oral intake. Physical examination was normal. Chest X-ray (CXR) demonstrated bilateral interstitial infiltration. Investigations including acute phase reactants were in the normal range. Multiplex PCR for viruses was negative and no bacterial infection was found. Real-time reverse transcription–polymerase chain reaction (RT–PCR) was negative for SARS-COV-2. He swiftly developed respiratory distress with filiform pulse, unmeasurable blood pressure, lethargy, and hepatomegaly on the second day, and was transferred to the paediatric intensive care unit, and promptly intubated. Acute phase reactants remained low with a 30 times elevated troponin T.
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