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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\u2019s 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.<\/jats:p>","DOI":"10.1136\/bcr-2020-237453","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T17:30:30Z","timestamp":1602091830000},"page":"e237453","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Metastatic pulmonary dissemination as differential diagnosis of COVID-19 disease"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5308-7088","authenticated-orcid":false,"given":"Cristel","family":"Perdig\u00f3n Martinelli","sequence":"first","affiliation":[{"name":"General Pediatrics, Hospital General de Castellon, Castellon de la Plana, Comunidad Valenciana, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Morell","sequence":"additional","affiliation":[{"name":"PICU, Hospital General de Castellon, Castellon de la Plana, Comunidad Valenciana, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"PICU, Hospital General de Castellon, Castellon de la Plana, Comunidad Valenciana, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Nova-Lozano","sequence":"additional","affiliation":[{"name":"Pediatric Oncology, Hospital Clinico Universitario, Valencia, Valenciana, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,7]]},"reference":[{"key":"2025082709352567000_13.10.e237453.1","article-title":"Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain","author":"Tagarro","year":"2020","journal-title":"JAMA Pediatr"},{"key":"2025082709352567000_13.10.e237453.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31103-X"},{"key":"2025082709352567000_13.10.e237453.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30361-5"},{"key":"2025082709352567000_13.10.e237453.4","unstructured":"Calvo Rey C , Garc\u00eda-L\u00f3pez Hortelano M , Tom\u00e1s Ramos J , et al . 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