COVID-19-related ARDS in a young infant with uncontrolled HIV after delay in EID.

BACKGROUND: COVID-19 has shown to cause generally mild disease in healthy children and adolescents. However, pediatric patients with primary immunodeficiency may develop severe and even fatal disease due to COVID-19. CASE PRESENTATION: We report the case of COVID-19-related acute respiratory failure in a 3.5-month-old infant with the diagnosis of vertical HIV transmission at disease presentation during the COVID-19 pandemic. The mother had received antiretroviral therapy from the third trimester of pregnancy and the infant had received dual neonatal prophylaxis. The first two postnatal HIV-RNA screenings immediately after birth and at the age of seven weeks were negative in this infant and follow-up screening had been planned at the age of 4 months. CONCLUSIONS: With the description of the disease presentation and clinical course, we intend to underscore awareness regarding the possibility of delayed diagnosis of vertical HIV transmission after previous antiretroviral drug exposure. We also demonstrate the delay in prevention of vertical transmission due to COVID-19 related pandemic barriers, which underscores the need for continuation of preventive services under all circumstances. Furthermore, this is the first pediatric report describing severe COVID-19 associated morbidity during immunocompromise caused by HIV.