Compressive Neuropathy of the Facial Nerve Presenting as Bell's Palsy in a Pediatric Patient on High-Frequency Oscillatory Ventilation.

A three-year eight-month-old female with Werdnig Hoffman disease presented with an acute onset of respiratory failure secondary to influenza infection. The patient required conventional mechanical ventilation (CMV). Due to worsening hypoxemia on maximal support, high-frequency oscillatory ventilation (HFOV) was initiated. On recovery from her respiratory failure, she was noted to have developed a left-sided Bell's palsy. A pressure ulcer in the left mastoid area through which the facial nerve transverses was noted, with no evidence of mastoiditis. The patient fully recovered after a course of oral steroid therapy. We postulate that compression pressure might have contributed to the palsy. However, it is unclear what role the acute viral illness played in this case.

COVID-19 Infection and Acute Pulmonary Embolism in an Adolescent Female With Sickle Cell Disease.

A previously healthy 20-year-old female presented to the emergency room in April 2020 with complaints of shortness of breath, chest pain, and cough. She was diagnosed with coronavirus disease 2019 (COVID-19) infection and pulmonary embolism (PE). Workup for anemia led to the diagnosis of sickle cell disease (SCD). Patients diagnosed with COVID-19 are at an increased risk for the development of PE and venous thromboembolism (VTE). Anticoagulation prophylaxis and escalation to treatment dosing are recommended in patients admitted with moderate to severe symptoms of COVID-19. PE and VTE are relatively uncommon in the pediatric and adolescent population. Most commonly, patients are diagnosed with thrombophilia or have an underlying hypercoagulable state such as with SCD. Also, symptoms of COVID-19 infection, acute chest syndrome (ACS), and PE can have overlapping features. In this report, we present a case of a late adolescent female with SCD, who was diagnosed with COVID-19, and whose condition was complicated with PE.