COVID Long-Hauler Syndrome in a Nigerian Child - A Case Report

Abstract

Introduction: Post-covid long-hauler syndrome has been observed in up to half of the children who had symptomatic Covid with symptoms lasting beyond 120 days.

Case report: PEC, is an 11year old female who presented with a history of unproductive Cough 5/7, Fever 5/7 and breathing difficulty. Physical examination revealed an acutely ill, dyspneic and tachypneic child, with a respiratory rate of 42 cycles/min. She had vesicular breath sounds and few basal crepitations. Her SPO2 was 75% in room air. The Chest Xray showed widespread nodular opacities. Her manteoux test was 3mm. A chest CT-scan showed diffuse in-homogenous densities with fibrocystic changes seen involving both lungs with associated areas of ground glass opacification in the upper lung bilaterally. Her COVID-19 PCR test was positive.  A diagnosis of COVID-19 disease was made. She was admitted into the paediatrics ward and treated with antibiotics and intranasal oxygen. Her SPO2 remained between 85-88% on oxygen and 75-79% in room air.  She became stable on the 6th day of admission and parents left against medical advice.

Four months post diagnosis the child presented with cough and breathlessness. A repeat chest x-ray showed massive lung infiltrates, multiple patchy opacities and hyperinflated lung fields. Her ESR was 30mm in the first hour. A lung function test was suggestive of severe restrictive/obstructive abnormality.  The 2- dimensional echocardiography was normal. A diagnosis of Post-covid 19 interstitial lung disease was made and she was placed low dose prednisolone 2mg/kg for six weeks. Her response to treatment will be assessed in subsequent follow-up.

Conclusion: Post COVID long-hauler syndrome is present in children who survive COVID-19. A high index of suspicion is required to diagnose and offer the correct treatment.