key: cord-0832099-hi21e94s
authors: Kashgari, Amna; Al Otaibi, Mohammed; Alharbi, Musaed
title: Lobar pneumonia in pediatric patient with COVID-19
date: 2020-07-18
journal: Int J Pediatr Adolesc Med
DOI: 10.1016/j.ijpam.2020.07.002
sha: 9483c0f594bf4c88cf9e154c1bb7dca5e4dd9cfa
doc_id: 832099
cord_uid: hi21e94s

nan

A five-year-old previously healthy girl presented to the emergency department with a non-productive cough, fever, and vomiting for two days. She had no other symptoms apart from a few episodes of diarrhea, mild abdominal pain, and no definite COVID-19-exposure history. Leukocyte and lymphocyte counts were normal; the CRP level was increased (100 mg/L). Blood coagulation was normal; serum ferritin (291-616 ug/ml) levels were increased. A chest X-ray showed consildation in the right lower lobe and middle lobe partially silhouetting the right cardiac border with air bronchogram consistent with pneumonia ( Figure 1) . Nucleic acid testing for SARS-CoV-2 was positive on the same day of admission. Blood oxygen saturation decreased rapidly soon after admission, with only 85-90% of the blood oxygen saturation being maintained on room air. She was connected to 2 L oxygen supply through a nasal cannula. At the same time, she was started on broad-spectrum antibiotics (ceftriaxone, vancomycin and azithromycin) and other supportive treatments (Intravenous Fluid Resuscitation). The patient eventually responded well to management, inflammatory markers started to trend down to normal, oxygen supply was weaned off (saturation was 95-100% on room air), and she was discharged after 11 days of hospitalization.

The SARS-CoV-2 (COVID-19) coronavirus is caused by an enveloped, single- The chest radiography in symptomatic children with positive COVID -19 could be normal. Nevertheless, wide spectrum of non-specific findings reported. 1,2 The most common findings were peribronchial cuffing and perihilar opacity. 3 The patchy bilateral ground-glass opacity (GGO), consolidation, or both were also reported. 1, 3 The distribution of the abnormality could be unilateral or bilateral with peripheral and lower lung zone predominance. Lobar pneumonia is atypical disease presentation. 1 Computed tomography of the chest showed bilateral peripheral and/or subpleural ground-glass or consolidative opacities often in the lower lobes of the lungs. Three phases of the disease were identified in chest CT-scan. 2, 4 Early phase: Focal consolidation with a rim of surrounding ground-glass opacity "halo" sign.

Progressive phase: progresses to ground-glass.

Developed phase: consolidative opacities. 

Emerging coronaviruses: genome structure, replication, and pathogenesis

International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting and Imaging Study Recommendations

Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults

Spectrum of Imaging Findings on Chest Radiographs, US, CT, and MRI Images in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

CT features of novel coronavirus pneumonia (COVID-19) in children