We present a child with a clear and classic COVID-19 symptomatic picture that rapidly progressed to sepsis with persistent hypertension. This patient, a five-year-old Hispanic female child was brought to our emergency department on March 21, 2020, with fever, productive cough, shortness of breath with chest tightness, abdominal pain, and diarrhea for a week. Her condition deteriorated rapidly, and she developed sepsis within 24 hours, needing intensive care unit admission and ventilator support. She tested negative for COVID-19 Biofire ® nucleic acid tests (BioFire Diagnostics, Salt Lake City, Utah 84108 USA); however, she was recently exposed to COVID-19 cases at her school. This case highlights the importance of a high index of COVID-19 suspicion in children in the endemic areas despite negative COVID-19 tests for keeping a watchful eye to prevent sudden deterioration and unexpected complications.
Vertebral osteomyelitis is an uncommon variant of osteomyelitis. Although Staphylococcus and/or Streptococcus are commonly associated, alternate pathogens have been implicated in vertebral osteomyelitis, especially in endemic areas and/or immunocompromised patients. Here, we present a case of a young African American female with type I diabetes mellitus who presented to us with worsening back pain. The MRI lumbar spine was suggestive of vertebral osteomyelitis involving the right facet joint of the fifth lumbar (L5) and the first spinal (S1) joint and a significant narrowing of the thecal sac at the L4-L5 vertebral level with an anterior epidural abscess. The patient was started on empirical antibiotics, and surgical intervention was performed with L4-L5 laminectomy and extraction of the epidural abscess. Her pus culture showed Eikenella corrodens as a possible cause of vertebral osteomyelitis. She had an uneventful recovery after two weeks of antibiotics (intravenous ceftriaxone) therapy.
We present a child with a new-onset isolated afebrile seizure in coronavirus disease 2019 (COVID-19). This patient, an 11-year-old Hispanic male, was brought to our ED in New York city on May 01, 2020, during the ongoing COVID-19 crisis with seizure. There was no fever and/or respiratory and gastrointestinal complaints. His general and systemic examination did not reveal any abnormality. Similarly, his biochemical profiles were within normal limits, and the radiological study, including a chest X-ray and CT scan, showed normal findings. His polymerase chain reaction (PCR) was positive for SARS-CoV2. The patient was admitted for observation after consultation with pediatric neurology, and his condition progressively improved with anti-seizure medications. This case highlights the need for recognizing an uncommon and atypical presentation in COVID-19 as the new cases are unfolding rapidly across the globe.
