Skill Checkup: A 17-Year-Old Male With Shortness of Breath, Cough With Green Sputum, Headache, and Low-Grade Fever

Enrico Brunetti, MD


November 07, 2022

Considering the patient's age, presentation, history, and low-flow oxygen status, appropriate treatment options to discuss include corticosteroids, IL-6 receptor blockers, Janus kinase inhibitors, and remdesivir. The WHO COVID-19 guidelines recommend that for patients with severe COVID-19 (oxygen saturation < 90% on room air, signs of pneumonia, or signs of severe respiratory distress), all four treatment types may be given. NICE guidelines advise that a course of remdesivir may be used for patients 12-17 years of age who weigh at least 40 kg and adults who have COVID-19 pneumonia and are in hospital on low-flow supplemental oxygen.

For hospitalized patients, the WHO recommends that convalescent plasma should be used only in research settings, and that ruxolitinib and tofacitinib should only be applied when neither barticitinib nor IL-6 receptor inhibitors are available.

Data on adults with COVID-19 can generally be extrapolated to older children with severe COVID-19 and predominantly lower respiratory tract disease. However, it is more challenging to extrapolate existing adult data to pediatric cases of SARS-CoV-2 infection and other respiratory viruses like asthma. No data have yet demonstrated that these conditions should be managed differently when caused by SARS-CoV-2 infection.

The patient responds well to dexamethasone and remdesivir and is discharged after 5 days. He is followed up by a pediatric allergy clinic.


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