Complete recovery post-covid-19 severe in patient with type 2 mucopolysaccharidosis

Abstract

INTRODUCTION: Children with comorbidities are at greater risk of developing severe forms of Covid-19. This paper reports a case of Mucopolysaccharidosis Type 2 (MPS-II) that presented complete recovery after severe Covid-19. CASE DESCRIPTION: Male, 13 years old, with MPS-II, is seen in a pediatric emergency room due to respiratory distress, airway hypersecretivity and fever. On physical examination, he had room air desaturation, snoring and diffuse coarse rales on pulmonary auscultation. Laboratory tests revealed: rod-like cell count, cytoplasmic vacuolization in neutrophils, thrombocytopenia, consumption coagulopathy, toxic level of valproic acid, respiratory acidosis and metabolic alkalosis; in addition to positivity for Covid-19. Chest radiography showed perihilar infiltrate with retrocardiac consolidation. Computed tomography of the chest showed bilateral perihilar and basal consolidations, in addition to bilateral endobronchial dissemination. Electrocardiogram showed changes in ventricular repolarization and ST-segment depression. Thus, Covid-19 infection was diagnosed, with secondary bacterial pneumonia and hemodynamic and cardiac repercussions, concomitant valproic acid intoxication. The patient required intensive care for 22 days, mechanical ventilation support for 19 days, in addition to the use of vasoactive drugs. He was discharged from hospital after 49 days, with gastrostomy, tracheostomy and home oxygen. COMMENTS: MPS-II carriers tend to have most severe form and worse prognosis when infected with Covid-19. This is because there are factors inherent to MPS-II that make it difficult to recover after pulmonary infections, such as: previous pulmonary dysfunction, macroglossia, adenoid hypertrophy, hypersecretivity and hypotonia. Such factors reflect the long hospital stay of patient reported when they get Covid-19.