Background Glucose-6-phosphate dehydrogenase deficiency is a rarely recognized predisposing factor for rhabdomyolysis. Rhabdomyolysis with coronavirus disease 2019 has been increasingly seen during the pandemic. We report the uncommon occurrence of coronavirus disease 2019 pneumonia, severe rhabdomyolysis, and acute renal failure in the setting of glucose-6-phosphate dehydrogenase deficiency. Case presentation A 19-year-old African American male presented with myalgias, diaphoresis, and dark urine. Testing for severe acute respiratory syndrome coronavirus 2 was positive. He had severe rhabdomyolysis with creatine kinase levels up to 346,695 U/L. He was oliguric and eventually required hemodialysis. Progressive hypoxemia, methemoglobinemia, and hemolytic anemia occurred following one dose of rasburicase for hyperuricemia. Glucose-6-phosphate dehydrogenase deficiency was diagnosed. Full recovery followed a single volume exchange transfusion and simple packed red blood cell transfusions. Conclusions Glucose-6-phosphate dehydrogenase deficiency may predispose individuals to rhabdomyolysis due to severe acute respiratory syndrome coronavirus 2, presumably due to altered host responses to viral oxidative stress. Early screening for glucose-6-phosphate dehydrogenase deficiency can be useful for management of patients with rhabdomyolysis.

INTRODUCTION:Sepsis remains a major cause of morbidity and mortality in critically ill children worldwide. Culture-negative sepsis (CNS) is diagnosed when a patient meets the criteria for sepsis with no causative pathogen identified. The etiology of CNS may be an uncultivable pathogen, treatment with antimicrobials before a culture was drawn, or a non-infectious cause. For adults, CNS is estimated to comprise up to 50% of all ICU admissions for sepsis, but the characteristics of the pediatric population with CNS are poorly understood. METHODS:This is a retrospective cohort study of 3 pediatric ICUs within an urban, tertiary children's hospital. All patients who received piperacillin-tazobactam, the institution's standard initial broad-spectrum agent, were screened for study inclusion. Patients ≤18 years old who were hospitalized between March 2020 and February 2021 and met the criteria for sepsis defined in the 2020 Pediatric Surviving Sepsis Guidelines were included in the study.

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