Unilateral Pleural Effusion in a Pediatric Patient: A Case of T-Cell Acute Lymphoblastic Leukemia Complicated with COVID-19

Exudative pleural effusion in children is mainly caused by bacterial infections. Here, we present a 2.5-years-old boy with acute fever, unilateral pleural effusion, and poor response to the insertion of chest tube.

The patient was admitted to the Taleghani Hospital of Gorgan (northeast of Iran) with complaint of fever starting from a week ago. The patient was treated with intravenous (IV) antibiotics and a chest tube was inserted. Considering the poor response to this treatment and leukocytosis, further assessments were made. Microbial examination of pleural fluid and SARS-CoV-2 test of nasopharyngeal swab were negative. Pleural biopsy and bone marrow aspiration analysis by flow cytometry revealed T-cell-acute lymphoid/lymphoblastic leukemia (ALL). The patient was referred to the oncology ward and chemotherapy was performed. After four weeks, he started to develop symptoms of respiratory distress, fever, and melena. The next SARS-CoV-2 test on throat swab was suspicious. Chest CT scan showed centrilobular ground glass opacity and peribronchial wall thickening in both lungs in favor of COVID-19. Treatment started with hydroxychloroquine, cotrimaxazole, meropenem, vancomycin, and pantoprazole. The patient was transferred to the PICU because of respiratory distress and decreased O2 saturation. Four days later, repeated test on nasopharyngeal swab was positive for COVID-19. Unfortunately, the patient did not respond to treatment and passed away a few days later.

T-cell ALL is an aggressive type of leukemia with poor response to treatment, and plural effusion is a rare presentation of malignancy in children. Our patient's condition was unfortunately complicated with COVID-19 involvement and he passed away before we see the effect of treatment on ALL.