engleski

Persistent multiple post - COVID complications with autonomic dysfunction in a 16- year old girl with end-stage renal disease

Introduction: The world is facing COVID-19 pandemic with a complex presentation. Moreover, many people are suffering from a variety of postCOVID symptoms. Although it appears that children experience less severe disease, those with underlying conditions such as chronic kidney disease (CKD) are more susceptible to infection and post-COVID syndrome Material and methods: We report a 16-year old girl who has been on peritoneal dialysis (PD) for the past 10 years. A kidney transplant was performed at the age of eight, complicated by early graft loss. The further course was characterized by many CKD related comorbidities including hypertension Results: In December 2020 she had a COVID-19 infection with pneumonia and encephalopathy. In the following months she developed suppurative hidradenitis, partially improved after adalimumab treatment. Pericarditis was diagnosed five months post-COVID and successfully treated with NSAIDs and intravenous immunoglobulins. More than 6 m o n t h s a f t er CO V I D - 1 9 i nf e c t i o n s h e s u f f e r e d f r o m numerous complications, including paroxysmal involuntary leg movements, memory and mood problems. The most severe of post- COVID disorders was refractory hypertension with blood pressure (BP) exceeding 200/100 mmHg. The Schellong test showed BP drops of >30%. Quantitative autonomic nervous system testing confirmed adrenergic score4, and cardiovagal score1 leading to diagnosis of orthostatic dysregulation with pronounced supine hypertension. Different combinations of antihypertensives have been tried, but without anticipated effect. Despite the conversion to hemodialysis and achieved fluid loss, BP 2878 Pediatric Nephrology (2022) 37:2803– 2969remained high for weeks. Recently, one year after COVID-19 infection, gradual improvement in BP has occurred Conclusions: There is a growing body of literature describing postCOVID complications in children with severe chronic diseases. In order to understand the complex underlying pathophysiological mechanism, further investigations and follow-up are required.

COVID-19 ; chronic kidney disease ; peritoneal dialysis ; children

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