New-Onset Diabetes in Children during COVID-19: Clinical Case Report

Abstract

Introduction. Data of COVID-19 in newborns and children are limited, and clinical manifestations are nonspecific and might delay the diagnosis, which might lead to severe complications. In this clinical case, we will describe new-onset diabetes with consciousness impairment as an atypical revealing way of COVID-19. Case. A 3-year-old child presented to the Emergency Department with loss of consciousness (without fever), lethargy, and stupor. Clinical assessment on admission found an unconscious child with a pediatric Glasgow Coma Scale of 10/15 with no localizing signs or meningeal syndrome, polypneic of 35 breaths/min, pulse oximetry of 90%, with signs of overall dehydration: skin folds, sunken eyes, tachycardia of 160 beats/minute, and recoloring time superior at 3 seconds. Laboratory findings showed hyperleukocytosis of 16000/mm3, lymphopenia of 450/mm3, glycemia of 5 g/L with a correct ionogram : corrected natremia of 139 mmol/L, serum potassium of 4.5 mmol/L, glycosuria of 3+, ketonuria of 2+, and HbA1c of 10%, and COVID-19 RT-PCR came back positive. Conclusion. COVID-19 might be revealed with atypical symptoms including new-onset diabetes and diabetic ketoacidosis; therefore, clinicians must suspect it in children with blood glucose and HbA1c at the time of admission. This will help to manage patients with hyperglycemia early.

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…The ACE2 receptor is strongly expressed in pancreatic endocrine tissue ( 119 ), predisposing patients to islet cell injury and diabetes, though not acute pancreatitis. New onset insulin-requiring diabetes in patients with COVID-19 has been reported in multiple studies and appears to persist after recovery from acute infection ( 118 , 120 , 121 , 122 , 123 ). Patients may present with severe hyperglycemia, including hyperosmolarity or ketoacidosis, or with milder hyperglycemia ( 124 , 125 , 126 , 127 ).…”

Epidemiological and Clinical Characteristics of Hospitalized Pediatric Patients with SARS-CoV-2 Infection in Mexico City, Mexico

“…The CO-RADS scale has not been validated in the pediatric population [ 34 ]; however, it has been found that patients younger than 15 years are less susceptible to alterations suggestive of SARS-CoV-2 infection according to the CO-RADS scale [ 35 ]. Additionally, another report found that the CO-RADS scale is not associated with the severity of SARS-CoV-2 infection [ 6 ].…”

Guillan barre syndrome in post Covid-19 infection in children

“…The clinical manifestations are non-specific leading to a delay on the management and potential complications [ 6 ].…”