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Cerebrovascular accident in a child with precursor B-cell acute lymphoblastic leukemia and coronavirus disease 2019:
Hanie Karimi1, Roham Sarmadian2, Abolfazl Gilani3
1Alumna of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
This case report highlights a rare instance of stroke in a child with leukemia and COVID-19. Early hospitalization is crucial for immunocompromised children with suspected COVID-19 to prevent severe complications like blood clots.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Hematology Oncology
Background:
- Coronavirus disease 2019 (COVID-19) poses severe risks to immunocompromised individuals, including those with leukemia undergoing anti-cancer treatments.
- Hypercoagulopathy is a known complication associated with both hematologic malignancies and COVID-19 infection.
- This report details a rare presentation of stroke in a pediatric patient with leukemia during the COVID-19 pandemic.
Observation:
- A 6-year-old girl with precursor B-cell leukemia and neutropenia tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- She developed acute respiratory distress, seizures, and neurological deficits including right parietal lobe ischemia and lower extremity paralysis.
- Cerebrospinal fluid analysis confirmed SARS-CoV-2 presence, indicating central nervous system involvement.
Findings:
- The patient experienced stroke, a rare but severe complication of COVID-19 in pediatric leukemia patients.
- Treatment included anti-seizure medications, corticosteroids, anticoagulation (heparin, enoxaparin), antiviral therapy (remdesivir), and supportive care.
- Neurological and speech impairments showed significant improvement after 10 months of rehabilitation and continued medical management.
Implications:
- Children with leukemia and suspected COVID-19 require prompt hospitalization due to their heightened risk of severe complications, including thrombotic events.
- Aggressive management of COVID-19 in pediatric leukemia patients is essential to mitigate life-threatening outcomes.
- This case underscores the importance of vigilance for neurological complications in immunocompromised children with SARS-CoV-2 infection.
Background:
Coronavirus disease 2019 can lead to rare but severe and life-threatening diseases in susceptible high-risk populations, including patients with immunodeficiency. A rare event in this report is stroke following COVID-19 disease in a patient with an immunocompromised background due to leukemia and anti-cancer treatments.
Case Presentation:
A 6-year-old iranian girl with precursor B-cell leukemia receiving vincristine therapy presented with fever and absolute neutrophil count < 500. Her severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was positive. During hospitalization, she had abrupt onset tachypnea, reduced O2 saturation, and generalized tonic-clonic seizures treated with phenytoin and levetiracetam. Right parietal lobe ischemia was found on a brain computed tomography scan, and the cerebrospinal fluid polymerase chain reaction test was positive for severe acute respiratory syndrome coronavirus 2. Several days later, she developed lower extremity paralysis and speech impairment, so speech therapy and physiotherapy were initiated. The patient also received dexamethasone, mannitol, heparin, and remdesivir. She was discharged with enoxaparin and levetiracetam. Chemotherapy resumed 2 weeks following discharge. Her speech and walking improved after 10 months of follow-up, and bone marrow aspiration showed total remission.
Conclusion:
Owing to the link between coronavirus disease 2019 and hematologic cancers with hypercoagulopathy and the tendency of patients with leukemia to have coronavirus disease 2019 complications, children with leukemia as well as suspected coronavirus disease 2019 must be hospitalized to prevent blood clot formation.
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