key: cord-268747-619eztla
authors: Bernar, Benoît; Kropshofer, Gabriele; Crazzolara, Roman; Kapelari, Klaus; Griesmacher, Andrea; Müller, Thomas; Scholl‐Bürgi, Sabine
title: SARS‐CoV‐2 infection in a 7‐year‐old girl with pancytopenia during acute lymphocytic leukemia maintenance therapy
date: 2020-08-11
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28391
sha: 
doc_id: 268747
cord_uid: 619eztla

nan

To the Editor:

Emerging in China in December 2019 1 and classified by the World Health Organization as causing pandemic disease in March 2020, 2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major challenge in most nations. Austria, especially the region of Tyrol, is no exception. Currently, within a Tyrolean pediatric population of ≈132 000 aged <18 years, 3 63 (0.05%) have had SARS-CoV-2 detected by PCR. Only two have been admitted to our pediatric department. In general, COVID-19 in children is rare, specifically in those aged <10 years, and its course appears milder than in adults. [4] [5] [6] However, some severe and even fatal cases in children have been reported. 7, 8 Systemic immunosuppression renders adult patients with cancer more susceptible to infection, 9 In mid-March, leukopenia, 1.5 G/L, and thrombocytopenia, 50 000 G/L, prompted a reduction in maintenance therapy. Three days later, COVID-19 was diagnosed in the patient's mother and the patient was reportedly febrile at night. Maintenance therapy was immediately suspended; as the patient's general health was good, she remained at home. Another 3 days later (day 4 of illness), high nonremitting fever with malaise prompted the child's hospital admission to a special isolation ward.

On evaluation, the patient's vital signs were unremarkable (heart rate 100 bpm, blood pressure 100/67 mm Hg, eupnea, temperature 36.0 • C). On room air, oxygen saturation was 100%. Mild rhinitis was evident; her skin was pale, without petechiae or purpura, although small hematomata were present. Pneumonia was not clinically sus- ALL maintenance therapy was resumed one week after discharge.

Of interest is that both parents worked in Tyrolean "hot spots" for COVID-19. The patient's brother was mildly ill when COVID-19 was diagnosed in the mother; he was not tested. The father was tested twice, without infection found.

Our experience with this patient-so far as we know, the first child with COVID-19 during pancytopenia induced by maintenance therapy for ALL-suggests reassuringly that the course of COVID-19 in pediatric patients can be mild even if assessed risk for complications is high, as with immunosuppression and pancytopenia. Our patient had only mild rhinitis with remitting fever and lingual blisters. Antibiotic and antiviral therapy was associated with swift improvement. Most importantly, her pulmonary status was clinically stable throughout her illness.

The authors would like to thank Günter Weiss, head of the Department of Internal Medicine II, responsible for the SARS-CoV-2-PCR results; Nina Gande for linguistical and grammatical correction of this manuscript; and Evelyn Rabensteiner, Teresa Fuchs, and Maria Sappler for close collaboration and support (pediatric oncology team

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