Case Report: Crying-triggered pallid and hypotonic episodes in a 6-week-old infant with SARS-CoV-2 infection—a diagnostic dilemma

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Crying-triggered pallid and hypotonic episodes in early infancy can be difficult to classify. We report a 44-day-old term female infant with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who experienced two crying-triggered episodes of marked pallor, limpness, and reduced responsiveness after cessation of crying, followed by spontaneous recovery. Neither event was physiologically recorded, and a definitive cause could not be established. No further episodes were reported during hospitalization or 8 weeks of follow-up. The clinical sequence suggested breath-holding spells (BHS) as one possible explanation alongside infection-associated apnea and other causes of paroxysmal events in early infancy. This case highlights the need for careful differential diagnosis of crying-triggered pallid and hypotonic episodes occurring during acute SARS-CoV-2 infection.