key: cord-0832899-lnwtsec3 authors: Babamahmoodi, Abdolreza; Moniri, Afshin; Sadr, Makan; Poorhosseini, Seyed Mohammad; Rezaei, Mitra; Marjani, Majid; Velayati, Ali Akbar title: Trisomy 21 as a Risk Factor for Severe Illness in COVID-19: Report of two Cases date: 2020-12-03 journal: Tanaffos DOI: nan sha: e6e7727fb2f4eda46091010fb26585d1d1e76ceb doc_id: 832899 cord_uid: lnwtsec3 COVID-19 leads to mild symptoms within the majority of infected patients, but can cause severe multiple organ failure and death. There is only limited information regarding the consequences of this new emerging infection with congenital disorders. According to the previous studies, many people with Down syndrome are considered high risk for complications related to respiratory diseases. We report two trisomy 21 patients who suffered from COVID-19 and summarize the early experience with COVID-19 and Down syndrome. The course of the disease was severe in these two cases, and our concern is close monitoring of the patients with Down syndrome for early signs of COVID-19. Triplication of chromosome 21 causes the conditions commonly referred to as Trisomy 21or Down syndrome (DS). DS is the most frequent chromosomal abnormality in the human population, and also the most common survivable autosomal aneuploidy (1) . are the most common cause of hospital admissions and increasing the mortality rate in patients with Down Syndrome (2) . Some related problems such as hypotonia, obstructive sleep apnea, craniofacial anomalies, immune deficiency, cardiac involvements and gastroesophageal reflux (GERD) can increase the risk of respiratory complications including aspiration pneumonia and recurrent pulmonary infection (3, 4) . Common clinical manifestations of coronavirus disease 2019 (COVID- 19) consist of fever, cough, myalgia, expectoration, dyspnea, headache, dizziness and diarrhea (5) . Infected patients may suffer multi-organ failure especially pulmonary and cardiovascular involvements (6). Given the above, we can expect that respiratory diseases in DS are more common than in healthy people who have COVID-19 diseases. In this paper, we report two patients with trisomy 21 who suffered COVID-19 and discuss the early experience with COVID-19 and DS patients. The were seen in sequential analysis of cellular immunity response. For every subset, the first column is the percentage of total lymphocyte and the second column is absolute count (per/µl). Case II was a 34-year-old female with DS (living in with her family) who came to our center ten days after her symptoms began. He had cough, shortness of breath, fever, myalgia, and hemoptysis. At the time of arrival to the hospital, oxygen saturation was about 69% in the room air without respiratory distress. In chest X-ray and pulmonary spiral CT scans, generalized ground-glass opacification was seen in both lungs (Figure 1 , C and D). Her sample from oropharyngeal gargling was positive for SARS-CoV-2 by RT-PCR assay. Other necessary information is shown in table 1. With supplemental oxygen, O 2 saturation increased to about 86%, but about eleven hours after being hospitalized in the infectious ward, her blood oxygen saturation dropped (to 55%) and developed respiratory distress. We found out that she had suffered from acute respiratory distress syndrome (ARDS) and immediately transferred to the ICU. She was intubated and was treated by antiviral (favipiravir), antibiotics (meropenem and vancomycin), Interferon beta 1-a, IVIG and hydrocortisone, but unfortunately she died three days later despite all efforts. 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