Table 1.
Patient demographics and clinical characteristics.
| Characteristic | Patient 1 | Patient 2 | Patient 3 | Patient 4 |
|---|---|---|---|---|
| Age (years) | 11 | 13 | 17 | 14 |
| Gender | Female | Male | Male | Male |
| Ethnicity/Race | Hispanic/White | Hispanic/White | Hispanic/White | Non-Hispanic/White |
| Relevant medical history | Obesity (BMI 30, 98% for age) | Severe aplastic anemia on immunosuppresive therapy | SARS-CoV-2 PCR positive 7 weeks prior to presentation | Obesity (BMI 32; 99% for age) |
| Presenting symptoms | 2 days of generalized abdominal pain, vomiting, fever | 1 day of generalized abdominal pain, nausea and vomiting | 1 day of generalized abdominal pain, nausea and vomiting | 4 days of abdominal pain, diarrhea, vomiting, congestion, anosmia, ageusia |
| Initial vital signs | T 37.3, HR 196, RR 22, BP 103/67, SpO2 99% RA | T 37.4, HR 98, RR 20, BP 117/63, SpO2 97% RA | T 37, HR 70, RR 22, BP 100/59, SpO2 97% RA | T 37.7, HR 97, RR 20, BP 132/87, SpO2 97% RA |
| Initial labs | ||||
| Hemoglobin (g/dL) | 11.2 | 7.7a | 13.0 | 16.9 |
| White blood count (103/μL) | 15.4 | 4.4a | 13.4 | 15.4 |
| Neutrophils (103/μL) | 12.5 | 3.7a | 11.6 | 11.5 |
| Lymphocytes (103/μL) | 1.27 | 0.18a | 0.92 | 2.3 |
| Platelets (103/μL) | 273 | 12a | 224 | 345 |
| Blood urea nitrogen (mg/dL) | 8 | 16 | 13 | 7 |
| Creatinine (mg/dL) | 0.5 | 0.8 | 0.9 | 0.8 |
| Aspartate transaminase (U/L) | 22 | 55 | 16 | 10 |
| Alanine transaminase (U/L) | 18 | 97 | 8 | 25 |
| Albumin (g/dL) | 4.6 | 4.4 | 4.0 | 4.5 |
| Blood culture | NA | +EC, +PA | NA | NA |
| SARS-CoV2 PCR | +NP swab (POD 0) | +NP swab (POD 0) +stool (POD7) |
+NP swab (POD -48) +NP swab (POD 0) |
+NP swab (POD 0) |
| Imaging findings | Dilated, fluid filled appendix with surrounding inflammation consistent with acute appendicitis without perforation or abscess | Dilated, fluid appendix with appendicolith and surrounding inflammation consistent with acute appendicits without perforation or abscess | Early acute appendicits without perforation or abscess | Dilated appendix with surrounding inflammation consistent with acute appendicits without perforation or abscess |
| Operative findings | Perforated appendictis with peritonitis | Necrotic appendicitis with peritonitis | Acutely inflamed appendix without perforation or surrounding inflammatory changes | Gangrenous appendix with associated peritonitis without rupture |
| Pathology findings | Acute appendicitis | Acute gangrenous appendicitis with perforation | Acute appendicitis and periappendicitis | Gangrenous appendicitis with periappendicitis |
| Day of discharge | POD 6 | POD 14 | POD 0 | POD 0 |
BMI, body mass index, kg/m2; T, temperature, degrees celcius; HR, heart rate, beats per minute; RR, respiratory rate, breaths per minute; BP, blood pressure, mm Hg; SpO2, oxygen saturation; RA, room air; POD, post-operative day; NA, not assessed; EC, Escherichia coli; PA, Pseudomonas aeruginosa; NP, nasopharyngeal; PICU, pediatric intensive care unit.
a
Baseline range over prior month: hemoglobin 4.9–8.5 g/dL; white blood count 1.56–2.64 103/μL; absolute neutrophil count 0.92–1.80 103/μL; absolute lymphocyte count 0.32–0.44 103/μL; platelets 5–13 103/μL (received platelet transfusions two days prior).