Dual Viral Infections and Para-Pneumonic Effusion in a Pediatric Patient: A Case of Respiratory Syncytial Virus and COVID-19 Complication

Para-pneumonic effusion in children is often associated with bacterial infections; however, dual viral infections, including respiratory syncytial virus (RSV) and COVID-19, can also lead to severe respiratory complications, as demonstrated in this case. This case report presents the clinical course of a pediatric patient with both RSV and COVID-19 infections, leading to para-pneumonic effusion. A three-year-old girl with a history of asthma and prior febrile convulsions presented to the Emergency Department with fever, cough, vomiting, and fatigue. Chest X-ray revealed left-sided pleural effusion. Initial laboratory results showed elevated inflammatory markers, including a white blood cell count of 22 x 10⁹/L, C-reactive protein (CRP) of 319 mg/L, and procalcitonin of 3.9 ng/mL. Nasal swab polymerase chain reaction confirmed RSV and COVID-19 co-infection. The patient was treated with intravenous ceftriaxone, azithromycin (to cover atypical pathogens), vancomycin (to address possible MRSA [methicillin-resistant <i>Staphylococcus aureus</i>]), and corticosteroids to manage severe inflammation with COVID-19. Following a six-day stay in the Pediatric Intensive Care Unit (PICU) for respiratory support and intravenous therapy, the patient showed significant clinical improvement. Serial imaging demonstrated a reduction in pleural effusion, and inflammatory markers decreased markedly. The patient was discharged after 29 days of hospitalization on oral antibiotics, in stable condition, with a follow-up scheduled. This case underscores the potential severity of dual viral infections in pediatric patients and the importance of prompt diagnosis and comprehensive management to prevent complications such as para-pneumonic effusion.