Can laboratory findings predict pulmonary involvement in children with COVID-19 infection?

BACKGROUND: Studies investigating clinical and imaging findings of coronavirus disease 2019 (COVID-19) pneumonia and predictors for lung injury mostly focus on adults. In this study, we aimed to evaluate the role of laboratory findings in predicting lung involvement in children with COVID-19. METHODS: Children with COVID-19 confirmed by reverse-transcription polymerase chain reaction or COVID-19 IgM and who underwent chest computed tomography (CT) scans were reviewed retrospectively. Admission absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC/ALC ratio, platelet count, D-dimer, fibrinogen, ferritin, procalcitonin, C-reactive protein (CRP), and lactate dehydrogenase levels were compared in patients with normal and abnormal CT scans. RESULTS: A total of 101 children were included. Among the patients, 68 (67.3%) had normal CT scans, and 33 (32.7%) had pulmonary involvement. The median CRP, ferritin, and fibrinogen levels were significantly higher in children with abnormal CT findings. The model of binary logistic regression based on the presence of cough, shortness of breath, fibrinogen, ferritin, and CRP levels showed that the possibility of having abnormal CT was 1.021 times more likely for every one unit increase in fibrinogen levels. CONCLUSION: Fibrinogen might be useful to predict pulmonary involvement of COVID-19 in children. Restricting radiological imaging to patients with significant symptoms and high fibrinogen levels might be helpful in children with COVID-19 infections.

Importance of neurologic and cutaneous signs in the diagnosis of Schimke immuno-osseous dysplasia.

Schimke immuno-osseous dysplasia is an autosomal recessive multisystem disorder caused by defects in SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1 gene (SMARCAL1). SMARCAL1 product is a helicase that has role in selective cellular proliferation. The disorder is characterized by spondyloepiphyseal dysplasia with short stature, nephropathy, T cell deficiency, neurologic and cutaneous signs. Patients may have hyperpigmented skin lesions similar to café au lait spots. Symptoms and disease severity in Schimke immuno-osseous dysplasia varies from patient to patient. Genetic, epigenetic and environmental factors play role on the severity of the disease. Here we report on a patient with short stature, steroid resistant nephrotic syndrome and recurrent infections. Cutaneous findings and developmental delay helped us to reach the diagnosis of Schimke immuno-osseous dysplasia. A homozygous missense mutation in SMARCAL1 gene confirmed the clinical diagnosis.