Complete Atrioventricular Block Complicated with Cardiogenic Shock as Primary Manifestation of a Novel Coronavirus Infection in a Child: A Rare Case Report

Abstract

Background: Since late 2019, the outbreak of Coronavirus Disease -2019 (COVID-19) has rapidly spread worldwide. Due to the novelty of this unknown disease, many of its manifestations are in an aura of ambiguity. Early data showed that children diagnosed with this virus had severe or critical situations combined with cardiovascular complications, such as myocardial injury, heart failure, ventricular dysfunction, shock, and even Kawasaki-like disease. We describe a cardiac involvement of this disease that presented with a complete atrioventricular block in a child.

Case presentation: A 4-year-old boy patient was admitted to the emergency department with a seizure and decreased consciousness level. Moreover, he was in a febrile state and a decreased level of oxygen saturation. Based on his critical situation, he was transferred to Pediatric Intensive Care Unit (PICU) and prepared to initiate invasive mechanical ventilation. High-resolution computed tomography revealed dependent significant grand gloss opacities with interlobular septal thickening in both lungs. The Polymerase chain reaction test confirmed “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”. An Electrocardiography showed a complete atrioventricular block pattern. According to the cardiac involvement, we prescribed a specific medication protocol. After 80 hours of PICU entrance and eight days after it, he was weaned from mechanical ventilation and discharged in good condition from the hospital.

Conclusion: It shows that rapid diagnosis of cardiac conduction system involvement of SARS-COVID-19 infection in children can enhance the prognosis. Furthermore, applying an optimal strategy for the treatment leads to effective therapy.