CASE REPORT:
An 8-day old male born at 37weeks by Caesarean section to Primigravida mother was referred to our unit with fever, lethargy, and respiratory distress. Mother was diagnosed with SARS-CoV2 infection at 29 weeks of gestation which was mild and had received symptomatic treatment. The total leukocyte count was 31200/cu.mm with 54% neutrophils, positive CRP, raised procalcitonin, and bilateral reticulonodular opacities involving middle and upper zones of lungs on chest radiograph (Table 1, Fig 1a). The neonate was initiated on broad spectrum antibiotics and nasal prong oxygen. Real-time reverse transcription polymerase chain reaction test (RT-PCR) for SARS- CoV2 was negative. Two Blood Cultures were sterile; Cerebrospinal fluid and urine cultures were normal. The infant continued to have fever spikes along with respiratory distress and oxygen requirement. Given the maternal history of COVID infection, nonspecific radiographic findings, with all cultures being sterile, additional investigations were carried out for presence of inflammatory markers, COVID antibodies, D-Dimer levels, 2D Echocardiogram and HRCT (Table 1, Fig 1b,c). High resolution Chest Tomography (HRCT) showed multiple nodules of varying sizes, conglomerate at places noted in both lungs. Majority of the nodules showed evidence of cavitation. Upon doing an interval scan, some nodules which were solid on the earlier scan showed evidence of cavitation. Imaging findings were suggestive of septic embolization of the lungs. Ultrasonography of the abdomen and contrast enhanced CT of whole body was done. Multiorgan affection with similar cavitary lesions or any malignant focus was ruled out. In view of the lab reports suggestive of inflammatory syndrome (leucocytosis, elevated CRP and Procalcitonin, and reactive COVID-19 antibodies) with non-resolving symptoms, a decision was taken to administer Intravenous Immunoglobulin (IVIG) at 1g/kg/day for 3 days following which the child became asymptomatic and was off oxygen support. In view of the cavitary lesions, investigation for active Tuberculosis was carried out in the neonate and the parents which were also negative. To rule out the possibility of malignancy other tumour markers like β- Human Chorionic Gonadotropin (HCG) and Alpha Feto Protein were done, which were within normal limits. Post IVIG, fever spikes subsided, distress gradually settled and neonate was discharged on breast feeds. On follow up, child is developmentally normal with adequate weight gain.