Egypt J Pediatr Allergy Immunol, (October 2022) , Volume No. 20, Issue 02  
Egypt J Pediatr Allergy Immunol 2022 ; 20 ( 02 ) : 69 - 77
, ESP - 341  
Original articles
Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis
Rasha El-Owaidy, Elham Hossny , Dalia El-Ghoneimy, Zeinab A. El-Sayed, Shereen Reda, Ihab Elhakim, Hanan Ibrahim, Iman Ragab, Nesrine Radwan, Ghada Shousha, Amal Lotfy, Amr Elmekkawy   Ali Sobh   Naglaa Osman   Roba Al-Gaweesh, Rana Zakaria, Mostafa El-Amin, Yehia El-Gamal      
Background: Data concerning the impact of COVID-19 on children with rheumatic disorders in developing countries are limited. Methods: We conducted a retrospective analysis, examining the medical records of 49 children (15 males, 34 females) with rheumatologic disorders who got infected with SARS-CoV2. They were recruited, over a period of 17 months, from the Children’s Hospitals of Ain Shams, Mansoura and Assiut Universities in Egypt. Data recorded were the type and duration of rheumatologic, antirheumatic treatment received, and COVID-19 presentation including severity, and outcome. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), lactate dehydrogenase enzyme (LDH), serum ferritin, and Ddimer levels were recorded. Results: Our series included 25 SLE, 16 JIA, two polyarteritis nodosa, two dermatomyositis, two mixed connective tissue disease, one systemic sclerosis, and one HSP patients. They had a median (IQR) age of 13 (10- 14) years. Twenty-nine (59.2%) patients had active disease flare. Forty-one (83.7%) patients were on corticosteroids, and 35 (71.4%) were on add-on immunosuppressives. Twenty-nine patients were hospitalized with a median (IQR) admission duration of 25 (14-38) days. They included 8 mild/asymptomatic, 4 moderate, 6 severe, and 11 critical COVID-19 cases. Seven cases with critical COVID-19 passed away with a mortality rate of 14.3 %. The deceased cases had higher neutrophil/lymphocyte ratio (p=0.003), higher CRP levels (p= 0.041), and higher D-dimer (p=0.001) and ferritin levels (0.002) as compared to survivors. Conclusion: Although reported to be milder in children, COVID-19 seems to have higher mortality among children with rheumatic disorders compared to rates reported in the general population. We could not find evidence for the impact of immunosuppressive treatment on COVID-19 related mortality, yet our findings need to be validated on wider scale prospective studies