A complicated presentation of pediatric COVID‐19 with necrotizing pneumonia and pulmonary artery pseudoaneurysms

• Published in: Pediatric Pulmonology 2021-12, Vol.56 (12), p.4042-4044
• Main Authors: Akuamoah Boateng, Gloria, Ristagno, Elizabeth H., Levy, Emily, Kahoud, Robert, Thacker, Paul G., Setter, Deborah O., Boesch, R. Paul, Demirel, Nadir
• Format: Article
• Language: English
• Subjects: Aneurysm, False - complications; Aneurysm, False - diagnostic imaging; Child; COVID-19; Humans; Letters to the Editor; Pneumonia, Necrotizing - complications; Pneumonia, Necrotizing - diagnostic imaging; Pulmonary Artery - diagnostic imaging; SARS-CoV-2
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.25631

In a meta-analysis, the most common bacterial co-infections with COVID-19 were Mycoplasma pneumonia, Pseudomonas aeruginosa, and Haemophilus influenza, in up to 14% of intensive care unit cases.3 Prevotella has not been described, but it has been demonstrated that overexpression of Prevotella proteins promotes viral infection through multiple interactions with nuclear factor kappa B; this interaction is implicated in increased COVID-19 clinical severity.4 Radiologically, the most commonly reported chest CT findings for COVID-19 pneumonia include ground glass opacities, linear consolidations and pleural thickening, and disease severity correlates with the extent of lobar involvement.2 NP, which presents with thin walled lung cavities, is rarely reported in COVID-19.1 NP is typically a complication of community acquired pneumonia. Staphylococcus aureus, Streptococcus pyogenes are commonly implicated.5 PAPAs are rarely defined as a complication of NP.5 Pathophysiologically, PAPAs form due to the pulmonary artery lacks an adventitial wall; therefore, repeated endovascular seeding of the pulmonary artery with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms.5 It is unclear how the COVID-19-associated prothrombotic state affectes development of PAPAs. Treatment options include transcatheter embolization with coils or endovascular stents, surgical ligation, or even wedge resections and lobectomy.5 In our case, after multidisciplinary discussion, intravascular occlusion was not pursued in the acute phase.