CASE REPORT:
An 8-day old male born at 37weeks by Caesarean section to Primigravida
mother was referred to our unit with fever, lethargy, and respiratory
distress. Mother was diagnosed with SARS-CoV2 infection at 29 weeks of
gestation which was mild and had received symptomatic treatment. The
total leukocyte count was 31200/cu.mm with 54% neutrophils, positive
CRP, raised procalcitonin, and bilateral reticulonodular opacities
involving middle and upper zones of lungs on chest radiograph (Table 1,
Fig 1a). The neonate was initiated on broad spectrum antibiotics and
nasal prong oxygen. Real-time reverse transcription polymerase chain
reaction test (RT-PCR) for SARS- CoV2 was negative. Two Blood Cultures
were sterile; Cerebrospinal fluid and urine cultures were normal. The
infant continued to have fever spikes along with respiratory distress
and oxygen requirement. Given the maternal history of COVID infection,
nonspecific radiographic findings, with all cultures being sterile,
additional investigations were carried out for presence of inflammatory
markers, COVID antibodies, D-Dimer levels, 2D Echocardiogram and HRCT
(Table 1, Fig 1b,c). High resolution Chest Tomography (HRCT) showed
multiple nodules of varying sizes, conglomerate at places noted in both
lungs. Majority of the nodules showed evidence of cavitation. Upon doing
an interval scan, some nodules which were solid on the earlier scan
showed evidence of cavitation. Imaging findings were suggestive of
septic embolization of the lungs. Ultrasonography of the abdomen and
contrast enhanced CT of whole body was done. Multiorgan affection with
similar cavitary lesions or any malignant focus was ruled out. In view
of the lab reports suggestive of inflammatory syndrome (leucocytosis,
elevated CRP and Procalcitonin, and reactive COVID-19 antibodies) with
non-resolving symptoms, a decision was taken to administer Intravenous
Immunoglobulin (IVIG) at 1g/kg/day for 3 days following which the child
became asymptomatic and was off oxygen support. In view of the cavitary
lesions, investigation for active Tuberculosis was carried out in the
neonate and the parents which were also negative. To rule out the
possibility of malignancy other tumour markers like β- Human Chorionic
Gonadotropin (HCG) and Alpha Feto Protein were done, which were within
normal limits. Post IVIG, fever spikes subsided, distress gradually
settled and neonate was discharged on breast feeds. On follow up, child
is developmentally normal with adequate weight
gain.