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Case report
Metastatic pulmonary dissemination as differential diagnosis of COVID-19 disease
  1. Cristel Perdigón Martinelli1,
  2. Carlos Morell2,
  3. Carolina González2 and
  4. Cristina Nova-Lozano3
  1. 1General Pediatrics, Hospital General de Castellon, Castellon de la Plana, Comunidad Valenciana, Spain
  2. 2PICU, Hospital General de Castellon, Castellon de la Plana, Comunidad Valenciana, Spain
  3. 3Pediatric Oncology, Hospital Clinico Universitario, Valencia, Valenciana, Spain
  1. Correspondence to Dr Cristel Perdigón Martinelli; cperdim7{at}


A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks’ duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing’s sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.

  • paediatric intensive care
  • paediatric oncology
  • infectious diseases

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  • Contributors Supervised by CM. Patient was under the care of CPM, CM, CG and CN-L. Report was written by CPM, MC and CG. Patient's signed form was completed by CM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.