A fatal SARS-coronavirus-2 induced bone marrow aplasia complicated with invasive fungal infection and severe neutropenic enterocolitis

The study “A fatal SARS-coronavirus-2 induced bone marrow aplasia complicated with invasive fungal infection and severe neutropenic enterocolitis” presents a case of a 6-year-old girl in Iran with severe complications following SARS-CoV-2 infection.

Here’s a detailed summary:

Background

  • Context: The study was conducted against the backdrop of ongoing COVID-19 vaccination efforts in Iran, with a focus on children under 12 who remain at risk due to lack of vaccination.
  • Case Overview: The patient, previously healthy, developed fever and pancytopenia (a reduction in the number of blood cells). Bone marrow biopsy showed hypocellular marrow without signs of leukemia or other blood disorders​​.

Case Presentation

  • Initial Diagnosis: Upon hospital admission, the patient presented with symptoms not typically associated with COVID-19 but suggestive of other conditions like aplastic anemia.
  • Complications and Treatment: Despite no typical COVID-19 symptoms, the patient developed a severe invasive fungal infection and neutropenic enterocolitis, ultimately leading to her death due to disseminated intravascular coagulopathy​​.

Discussion and Conclusions

  • Mechanisms of Complications: The study highlights the varying impact of SARS-CoV-2 on the immune system, particularly on T lymphocytes. It suggests that severe cases may lead to bone marrow-induced aplasia, a condition where the bone marrow significantly reduces or stops producing blood cells​​.
  • Comparison with Aplastic Anemia: The report distinguishes the patient’s condition from primary and secondary aplastic anemia, noting that similar conditions have been observed following other viral infections​​.
  • Cross-Reactivity with HIV Tests: The case presented a diagnostic challenge due to the cross-reactivity of SARS-CoV-2 with the fourth-generation p24 HIV antigen/antibody assay, leading to false-positive HIV test results. This highlights the need for careful diagnostic procedures when dealing with COVID-19 infections​​.
  • Clinical Implications: The study underscores the potential severity of SARS-CoV-2 infections in children, which may lead to serious hematological abnormalities, requiring immediate medical attention and possibly resulting in increased mortality. It also emphasizes the association of SARS-CoV-2-induced bone marrow aplasia with secondary bacterial and fungal infections​​.

Significance

This case report provides valuable insights into the atypical and severe manifestations of COVID-19 in children, particularly highlighting the need for pediatricians to be vigilant for unusual signs and symptoms that may mimic other conditions. It also underscores the complexities involved in diagnosing and managing such cases, considering the potential for misdiagnosis and the severity of complications that can arise.

Read More: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07599-6

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