COVID-19 Publications

In pediatrics, viral infections precede approximately 60% of cases of immune thrombocytopenia (ITP) and 15% of cases of autoimmune hemolytic anemia (AIHA). Here, we describe two previously healthy children, each diagnosed with an autoimmune cytopenia associated temporarily with SARS‐CoV‐2 viral infection, one with acute ITP and one with AIHA.

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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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Background Immunosuppression is considered a risk factor for more severe clinical presentation of COVID-19. Limited data regarding clinical outcome exist in adults, whereas very little is known about the spectrum of the disease in pediatric heart transplant recipients.

Methods We retrospectively reviewed the charts of young heart transplant patients from our tertiary care center during the coronavirus pandemic in New York City and identified patients infected with SARS-CoV-2.

Results We present four cases with COVID-19 disease and elaborate on their presentation and clinical course.

Conclusions Although far from conclusive and limited by the small sample size and selection bias, these cases demonstrate mild and self-limited disease despite immunosuppressive therapy and various comorbidities that are expected to increase the severity of the clinical picture based on extrapolation from the adult experience with this novel disease.

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Background Chilblains (“COVID toes”) are being seen with increasing frequency in children and young adults during the COVID-19 pandemic. Detailed histopathological descriptions of COVID-19 chilblains have not been reported, and causality of SARS-CoV-2 has not been established yet.

Objective To describe histopathological features of Covid-19 chilblains and explore the presence of SARS-CoV-2 in the tissue.

Methods We examined skin biopsies from 7 paediatric patients presenting with chilblains during the COVID-19 pandemic. Immunohistochemistry for SARS-CoV-2 was performed in all cases and electron microscopy in one.

Results Histopathology showed variable degrees of lymphocytic vasculitis ranging from endothelial swelling and endothelialitis to fibrinoid necrosis and thrombosis. Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were also seen. SARS-CoV-2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of endothelial cells on electron microscopy.

Conclusions Although the clinical and histopathological features were similar to other forms of chilblains, the presence of viral particles in the endothelium and the histological evidence of vascular damage, support a causal relation of the lesions with SARS-CoV-2. Endothelial damage induced by the virus could be the key mechanism in the pathogenesis of COVID-19 chilblains and perhaps also in a group of patients severely affected by COVID-19 presenting with features of microangiopathic damage.

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