Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive Care2219-40612587-6554Eco-Vector98810.17816/psaic988Research ArticleTreatment of a patient with COVID-19 and adverse premorbid background: A case reportTulokhonovaJulia S.<p>anesthesiologist-resuscitator</p>se_yu@mail.ruhttps://orcid.org/0000-0003-3220-9549ObarchukOksana G.<p>anesthesiologist-resuscitator</p>oxya_ne@mail.ruhttps://orcid.org/0000-0002-5541-7335AverinaIrina A.<p>anesthesiologist-resuscetator</p>nsaplina@rambler.ruhttps://orcid.org/0000-0003-1527-7005Ivano-Matryoninsk Children’s Hospital131020211133954020308202112082021Copyright © 2021, Tulokhonova J.S., Obarchuk O.G., Averina I.A.2021<p><strong><em>BACKGROUND:</em></strong> In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults.</p>
<p><strong><em>CASE REPORT:</em></strong> This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m<sup>2</sup>, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acidbase balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation.</p>
<p><strong><em>CONCLUSION:</em></strong> Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.</p>novel coronavirus infection COVID-19pneumoniaobesityDown syndromechildrenновая коронавирусная инфекция COVID-19пневмонияожирениесиндром Даунадети[Berlin DA, Gulick RM, Martinez FJ. Severe COVID-19. The New England Journal. 2020;383:2451–2460. DOI: 10.1056/NEJMcp1009575][Kwok S, Safwaan A, Ho JH, et al. Obesity: A critical risk factor in the COVID-19 pandemic. Clinical Obesity. 2020;10(6):e12403. DOI: 10.1111 / cob.12403][Stefan N, Birkenfeld AL, Schulze MB, Ludwig DS. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. 2020;16(7):341–342. DOI: 10.1038 / s41574-020-0364-6][Ferruzzi A, Gasparini L, Pietrobelli A, et al. Childhood obesity and SARS-CoV2: dangerous liaisons. Child and Adolescent Obesity. 2021;4(1):89–97. DOI: 10.1080/2574254X.2021.1883393][Wardell S, Wall A, Bryce R, et al. The association between obesity and outcomes in critically ill patients. Can Respir J. 2015;22(1):23–30. DOI: 10.1155/2015/938930][Csige I, Ujvarosy D, Szabo Z, et al. The Impact of Obesity on the Cardiovascular System. Journal of diabetes research. 2018;3407306. DOI: 10.1155/2018/3407306][Verbovoy AF, Pashentseva AV, Sharonova LA. Obesity and cardiovascular system. Clinical Medicine. 2017;95(1):31–35. (In Russ.) DOI: 10.18821/0023-2149-2017-95-1-31-35][Robinson PD. Obesity and it’s impact on the respiratory system. Paediatric Respiratory Reviews. 2014;15(3):219–226. DOI: 10.1016 / j.prrv.2014.06.003][Boykov VA, Kobyakova OS, Deyev IA, et al. State of respiratory function in patients with obesity. Bulletin of siberian medicine. 2013;12(1):86–92. (In Russ.) DOI: 10.20538/1682-0363-2013-1-86-92][Mokrysheva NG, Galstyan GR, Kirzhakov MA, et al. COVID-19 pandemic and endocrinopathies. Problems of endocrinology. 2020;66(1):7–13. (In Russ.) DOI: 10.14341/probl12376][Amin A, Chitsazan M, Taghavi S, et al. Effects of triiodothyronine replacement therapy in patients with chronic stable heart failure and low-triiodothyronine syndrome: a randomized, double-blinde, placebo-controlled study. ESC Heart Fail. 2015;2(1):5–11. DOI: 10.1002/ehf2.12025][Callea M, Cammarata-Scalisi F, Galeotti A, et al. COVID-19 and Down syndrome. Acta pediatrica. 2020;109:1901–1902. DOI: 10.1111/apa.15409][Espinoza JM. Down syndrome and COVID-19: A Perfect Storm? Cell Reports Medicine. 2020;1(2):100019. DOI: 10.1016 / j.xcrm.2020.100019][Clift AK, Coupland CAC, Keogh RH, et al. COVID-19 Mortality Risk in Down Syndrome: Results from a Cohort Study of 8 Million Adults. Annals of internal medicine. 2021;174(4):572–576. DOI: 10.7326/M20-4986][Wang K, Zhang Zh, Yu M, et al. 15-day mortality and associated risk factors for hospitalized patients with COVID-19 in Wuhan, China: an ambispective observational cohort study. Intensive Care Med. 2020;46(7):1472–1474. DOI: 10.1007/s00134-020-06047-w][Xie J, Tong Zh, Guan X, et al. Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China. JAMA Netw Open. 2020;3(4):e205619. DOI: 10.1001/jamanetworkopen.2020.5619][Ludvigsson JF. Systematic review of COVID-19 in children show milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088–1095. DOI: 10.1111/apa.15270][Dong Y, Mo X, Hu Y, et al. Epidemiological Characteristics of 2143 Pediatric Patients with 2019 Coronavirus Disease in China. Pediatrics. 2020. DOI: 10.1542/peds.2020-0702. Available at https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf]