Abstract

Background: We report a patient who was a child and developed septic shock and severe acute respiratory distress secondary to covid-19 infection to examine the cause of the changes and provide a theoretical basis for shock management.
Case report: On April 9th, a 14-year-old Iranian boy, a known case of cerebral palsy and convulsion, was admitted to a local hospital in a shocking state. On admission, his blood pressure was 88/54 mmHg, respiratory rate was 32 breaths/min, pulse rate was 178 beats/min, body temperature was 39/5 c, oxygen saturation was 66% but increased to 87% when she received 3-5liter oxygen from face mask; physical examination showed intercostal retraction, decreased breathing sound in left side, delayed capillary filling, cold extremities with a weak pulse. Acute resuscitation including dopamine 90mg in 50cc Dextrose 5%/water in 10 hours, endotracheal intubation, mechanical ventilation, and hydration with 1700cc D/W 5% (77meq NaCl and 20meq KCl were added too) was done. A broad spectrum of empirical antibiotic therapy was started. Testes showed WBC was higher than the reference interval, lymphocyte count was lower than reference intervals, hemoglobin was lower than the reference interval and platelets count was higher than the reference interval. Blood culture showed positive infectious of staphylococcus aureus. Chest X-ray showed left side pleural effusion. HRCT showed increased vascularity and peripheral basal part ground-glass opacification with a left side left lower lobe collapse. Throat swabs tests were positive for covid-19 nucleic acid so a definitive diagnosis of covid-19 was concluded. Hydroxychloroquine 200mg twice daily and Lopinavir/Ritonavir 300mg twice daily were started. After resuscitation, his body temperature was 37.1c, Respiratory rate was 20 breaths/min with mechanical intubation, Heart rate was 148 beats/min, Blood pressure was 98/75 mmHg and she was transferred to the pediatric intensive care unit after stable condition.
Conclusion: We hypothesize, that air-blood barrier deficit due to covid-19 may lead to transmission of preexisting pneumonia or other bacterial infection in respiratory tracts and causes bacterial sepsis. Further study is needed. Treatment of septic shock requires hemodynamic support with the administration of vasopressors, crystalloid solutions, broad-spectrum anti-biotic, antiviral treatment, high flow of oxygen therapy, and mechanical intubation if the shock is accompanied by acute respiratory distress was helpful for pediatric.

Keywords:Case report; Septic shock; Severe acute respiratory distress; Coronavirus disease 2019; Pediatric

Abbreviations:COVID-2019: Coronavirus Disease 2019; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; D/W: Dextrose/Water; NaCl: Sodium Chloride; KCL: Potassium Chloride; HRCT: High Resolution Computed Tomography; ICU: Intensive Care Unit; Po2: Partial Pressure of Oxygen; Pco2: Partial Pressure of Carbon Dioxide; FIo2: Fraction of Inspired Oxygen; HCO3: Bicarbonate Blood Urea Nitrogen; ESR: Erythrocyte Sedimentation Rate; CRP: C Reactive Protein