They were finally discharged from the hospital after six days, without need for ICU admission. They received supportive care, antiviral drugs, and appropriate antibiotics. The chest computed tomography findings were similar ground-glass opacities in lower lobes in both patients ( Figure 1). Elevated C-reactive protein (CRP) was detected in one of them ( Table 2).
Laboratory data revealed leukopenia and positive reverse transcription polymerase chain reaction (RT-PCR). They did not have any respiratory symptoms. They suffered fever, headache, nausea, vomiting, and diarrhea. Their clinical presentation was atypical. They had continuous exposure to their infected grandfather. They did not have any underlying diseases. These two 9-year-old patients were monozygotic twin boys ( Table 1). CT findings were reported and discrepancies were tackled via discussion. All images were reviewed by a pediatric radiologist. It should be noted that all patients had a chest radiograph (CXR) before computed tomography (CT) scan examination.
We reviewed the clinical assessments, laboratory and imaging findings of these patients from electronic records. We report these pediatric patients with typical and atypical presentation of COVID-19 infection and heterogeneous unexpected features in their imaging.Īll patients were under 18 years old with clinical symptoms of acute respiratory infections at the beginning or after admission who underwent computed tomography imaging and had confirmed COVID-19 infection (nucleic acid test, throat swab samples). This study was conducted in a one-month period from 1 March 2020 until 1 April 2020 according to relevant guidelines and regulations in the Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. This emphasizes the need for more data from other parts of the world to discover the potential hidden aspects of the disease in the pediatric population. Previously published data are mainly from China, but less than 10% of confirmed cases are now from this country. In the pediatric population, the symptoms were initially reported to be absent or mild, but with an increasing number of affected patients more symptomatic children are being encountered ( 5, 6). The first reported case was a 7-year-old boy with cough and fever confirmed on 19 January 2020 ( 4). A review by the Chinese Center for Disease Control and Prevention demonstrated that among 72,314 cases, less than 1% were children younger than 10 years old ( 3). The infectious rate of COVID-19 is relatively lower in children ( 2).
The susceptible population are mainly adults and those with a suppressed immune system. WHO declared the infection as a global health emergency on Janu( 1). On 11 February 2020, the World Health Organization (WHO) officially named the disease caused by this organism as coronavirus disease of 2019 (COVID-19). The causative virus was found to be a new coronavirus. On 31 December 2019, an unknown viral pneumonia was reported from Wuhan, China. Some of the patients managed easily, but others had prolonged hospital stay, especially patients with significant underlying conditions. The empirical regimen in our hospital included hydroxychloroquine and oseltamivir. Subpleural consolidation, peribronchial thickening, round consolidation, and Halo sign was depicted. Computed tomography was abnormal in 83.3% of patients. Tachypnea (75%) represented the most common physical finding. Six patients had an underlying disease and atypical findings with no clinical suspicion at the beginning. In this case-series, we report twelve patients with clinical symptoms of acute respiratory infections at the beginning or after admission who have polymerase chain reaction (PCR)-proved (throat swab samples) COVID-19 infection and underwent computed tomography imaging. Our objective was to evaluate clinical and computed tomographic features in hospitalized children with coronavirus disease 2019 (COVID-19) infection who were admitted to the pediatric center of excellence, children’s medical center.