Page 103 - Abstract Book KONIKA 18

Allergy Immunology

P-AI-001
Henoch-Schönlein in Children with COVID-19: A Case Report

Astrid Maharani Putri, Nia Kurniati
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital,
Jakarta, Indonesia
Abstract
Background Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis of childhood.
Comorbidity with concurrent COVID-19 which has similar hyperinflammatory condition leads to its
treatment modification. Objective To demonstrate diagnostic and management of HSP with COVID-19 co-
infection. Case A 9-year-old boy presented with purpuric rash predominantly in lower limbs for 2 weeks.
The symptoms extended to diffuse abdominal pain, joint pain, and painful scrotal swelling. He was initially
treated with herbal remedies and given steroid for 3 days which failed to alleviate the scrotal pain. He also
developed a cough on the day of admission. Physical examination revealed palpable purpura, abdominal
tenderness, arthritis, and inflammation of the scrotum. Laboratory data showed thrombocytosis, leucocytosis,
high levels of ESR, CRP and d-Dimer. Urinalysis showed microscopic haematuria and microalbuminuria.
Doppler ultrasonography identified an epididymo-orchitis. The PCR test for SARS-CoV-2 was positive.
He was initially treated with 2 mg/kg/day intravenous methylprednisolone (MP) and oral favipiravir. After
completion of laboratory test, he was then given 10-15 mg/kg/day intravenous MP, subcutaneous enoxaparin,
and remdesivir instated in place of favipiravir. Within 3 days, all the classic symptoms of HSP and orchitis
resolved. Patient was discharged after fulfilled COVID-19 treatment. Conclusion HSP is an inflammatory
disease. Concurrent infection with COVID-19 with hyperinflammatory evidence increased the possibility of
organ damage in order that its management should be adjusted to individual conditions with careful monitoring.
Keywords: Henoch-Schönlein purpura; COVID-19

P-AI–002
Management of Systemic Lupus Erythematosus in Children During Covid-19
Pandemic: A Case Report

Afrilia Intan Pratiwi, Cahya Dewi Satria, Sumadiono
Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr.Sardjito
Hospital, Yogyakarta, Central Java, Indonesia
Abstract
Background Coronavirus disease-19 (COVID-19) pandemic has devastated the world with high mortality
associated with severe complications including acute respiratory distress syndrome (ARDS). Systemic Lupus
Erythematosus (SLE) patients have impaired immune response which may increase their susceptibility to
COVID-19 infection. On the contrary, cytokine storm following hyperactive immune response are known to
play a pivotal role in progression of severe COVID-19. Moreover, the role of immunosuppressive agents in
SLE patient with COVID-19 remain largely elusive. Objective To elucidate immunosuppressant role in the
management of SLE patient with COVID-19. Case An 11-year-old female was diagnosed with severe SLE
based on ARA criteria in our hospital. She also had moderate symptom of COVID-19 with pneumonia. The
patient was hospitalized in our isolation ward and received antibiotics, antivirals, vitamin C, vitamin D, zinc
and methylprednisolone. Laboratory examination showed high ferritin, D-dimer, and fibrinogen level that
marks a COVID-19 infection despite the regular dose methylprednisolone administration. Methylprednisolone
was subsequently increased into full dose for SLE treatment, and the patient condition was gradually
improved. On the 14th day after admission, patient had negative PCR COVID-19 and transferred to non-
isolation ward. Ultimately, the patient was treated with combination of intravenous methylprednisolone and
cyclophosphamide. No complication was observed during the course of treatment for SLE and COVID-19.
Finally, she was discharged after 18 days of hospitalization. Conclusion Immunosuppressive agents might
be beneficial in SLE patients with COVID-19.
Keywords: systemic sulpus erythematosus; COVID-19; immunosuppressive agent

KONIKA XVIII Abstract Book 55