Table 1.
Clinical characteristics of immunocompromised children with COVID-19 disease
| Case # | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Age (years) | 15 | 13 | 12.6 | 9 | 6.7 | 11 | 12.6 | 14.8 |
| Gender | F | M | M | M | M | M | F | M |
| Primary disease |
HSCT PID (CTLA4 deficiency) |
HSCT Myelodysplastic syndrome |
HSCT B-ALL |
T-ALL | Melanoma | Liver Tx |
C-ANCA vasculitis. Hemodialysis |
Kidney Tx |
| Immunosuppressive treatment/targeted therapy | None (stopped for 1 month). CD4 cells: 216/ μL | Ruxolitinib | None (stopped for 2 months). CD4 cells: 30/ μL | Oral mercaptopurine and methotrexate | Trametinib | Prednisone, tacrolimus | Prednisone, azathioprine | Prednisone, tacrolimus, mycophenolate (MMF) |
| Fever | Yes | No | Yes | Yes | No | Yes | Yes | No |
| Cough | No | No | No | Yes | Yes | Yes | Yes | Yes |
| Sore throat | No | Yes | No | No | No | No | Yes | No |
| Dyspnea | Yes | No | No | No | No | No | No | No |
|
Lymphocytes/mm3 (minimum value) |
730 | 1210 | 520 | 340 | 2730 | 970 | 380 | 1620 |
|
D-dimer ng/mL (maximum value) |
301 | - | 418 | 1143 | 370 | - | 1168 | - |
| IL-6 pg/mL (maximum value) | 9.60 | 2.30 | - | 192 | - | - | - | - |
| C- Reactive Protein (mg/L) | 26.2 | 1.9 | 18.9 | 24.6 | 0.6 | 0.9 | 9 | 106 |
| Ferritin (mg/dl) | Not done | Not done | 622 | 1534 | Not done | Not done | 1270 | 553 |
| Chest X-ray |
Normal (Previous lobectomy) |
Interstitial infiltrate | Interstitial infiltrate | Interstitial infiltrate | Focal infiltrate | Mild parahilar infiltrates | Normal initially but focal infiltrate on evolution | Focal infiltrate |
| Required hospitalization | Yes | No | No | Yes | No | Yes | Yes | Yes |
| Treatment |
HCQ* Remdesivir** |
IS withdrawal | HCQ* |
IS withdrawal HCQ* Remdesivir** Tocilizumab Dexamethasone*** |
Trametinib withdrawal | Reduction in IS (50% tacrolimus reduction) |
Reduction in IS (azathioprine withdrawal) LPV/Rtv HCQ* |
Reduction in IS (MMF withdrawal, tacrolimus decrease and prednisone increase) HCQ* |
| Duration of stay (days) | 11 | - | - | 28 | - | 3 | 4 | 2 |
| Complications | O2 requirement on nasal cannula (maximun 2 lpm) | None | None | HLH-like syndrome | None | None | None | None |
F female, M male, HSCT: hematopoietic stem cell transplant, PID primary immunodeficiency, B-ALL: B cell acute lymphoblastic leukemia, T-ALL T cell acute lymphoblastic leukemia, Tx transplant, HCQ hydroxychloroquine, IS immunosuppressors, LPV/Rtv lopinavir/ritonavir, O2 oxygen; HLH hemophagocytic lymphohistiocytosis. MMF mycophenolate
*HCQ was initiated in patients 1, 3, 4, and 8 once confirmation of positive SARS-CoV-2 with a nasal swab was obtained (< 24 h from consultation at our hospital). Patients 1, 3, and 8 attended the Emergency Department in the first 24 h after onset of symptoms. Patient 4 had fever of 4 days when the nasal swab was obtained, and patient 7 received 5 days of LPV/Rtv initially and due to persistent symptoms was switched to HCQ. According to our guidelines, the oral dose was as follows: HCQ 6.5 mg/kg/day (dosing q12 h) in 6 year-olds, and HCQ 10 mg/kg/day (dosing q12 h) in children > 6 years (maximum daily dose 400 mg) for 5 days
**Remdesivir was given for a total of 7 days on patient 1 and 10 days on patient 4, at an intravenous dose of 5 mg/kg on day 1, followed by a maintenance dose of 2.5 mg/kg from days 2 to 9 (patients <40 kg) or 200 mg/iv on day 1 followed by 100 mg/iv on days 2-9 (for patients >40 kg)
***Dexamethasone was given as per the HLH 2004 trial, although with a shorter duration: 10 mg/m2/day for 7 days, followed by 5 mg/m2/day for another 7 days, followed by 2.5 mg/m2 for 7 days and 1.25 mg/m2 for 2 days and then a tapering dose with hydrocortisone