Multisystem inflammatory syndrome in a child associated with COVID-19: a clinical case report
DOI:
https://doi.org/10.14739/2310-1210.2023.4.279043Keywords:
systemic inflammatory response syndrome, COVID-19, childrenAbstract
Multisystem inflammatory syndrome in children (MIS-C) who contracted COVID-19 remains an urgent problem. Mortality due to this disease among children ranges from 0.8 % to 2.0 %. According to reports found in the literature, MIS-C can develop both in children who have experienced COVID-19 without clinical manifestations, and in those who have had a severe course of the disease.
To date, there are no well-defined factors that allow predicting the risk of developing MIS-C in children after experiencing COVID-19, and the spectrum of clinical manifestations can be quite diverse.
Aim: on the example of a specific case, to examine and analyze the features of the course and the range of diagnostic measures in children with MIS-C using an analytical method and a systemic approach.
Materials and methods. The material was a clinical case of MIS-C, methods of instrumental diagnosis and objective analysis. The diagnosis of MIS-C was based on the WHO 2021 criteria for the diagnosis of MIS-C associated with COVID-19.
Results. The clinical case of MIS-C associated with COVID-19 in a child with congenital thymus pathology that resulted in rapid, aggressive, and worsening multiple organ failure was studied. The manifestations were dominated by liver failure, respiratory failure, circulatory failure, and neurological deficiency, that led to the child’s death.
Conclusions. Multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection can lead to serious and life-threatening complications in previously clinically healthy children.
Physicians need to be more alert to children of different age groups with manifestations of respiratory infections as potential COVID-19 and to test for its presence, which will subsequently allow timely identification of children with MIS-C associated with SARS-CoV-2.
Considering the probable role of the thymus in the pathogenesis and course of MIS-C associated with SARS-CoV-2, we recommend an ultrasound examination of the thymus for all children under 3 years of age with confirmed COVID-19 and followed by examination of T-cellular response if changes are detected.
References
Belay, E. D., Abrams, J., Oster, M. E., Giovanni, J., Pierce, T., Meng, L., Prezzato, E., Balachandran, N., Openshaw, J. J., Rosen, H. E., Kim, M., Richardson, G., Hand, J., Tobin-D'Angelo, M., Wilson, S., Hartley, A., Jones, C., Kolsin, J., Mohamed, H., Colles, Z., … Godfred-Cato, S. (2021). Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic. JAMA pediatrics, 175(8), 837-845. https://doi.org/10.1001/jamapediatrics.2021.0630
Dufort, E. M., Koumans, E. H., Chow, E. J., Rosenthal, E. M., Muse, A., Rowlands, J., Barranco, M. A., Maxted, A. M., Rosenberg, E. S., Easton, D., Udo, T., Kumar, J., Pulver, W., Smith, L., Hutton, B., Blog, D., Zucker, H., & New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team (2020). Multisystem Inflammatory Syndrome in Children in New York State. The New England journal of medicine, 383(4), 347-358. https://doi.org/10.1056/NEJMoa2021756
Riphagen, S., Gomez, X., Gonzalez-Martinez, C., Wilkinson, N., & Theocharis, P. (2020). Hyperinflammatory shock in children during COVID-19 pandemic. Lancet (London, England), 395(10237), 1607-1608. https://doi.org/10.1016/S0140-6736(20)31094-1
Verdoni, L., Mazza, A., Gervasoni, A., Martelli, L., Ruggeri, M., Ciuffreda, M., Bonanomi, E., & D'Antiga, L. (2020). An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet (London, England), 395(10239), 1771-1778. https://doi.org/10.1016/S0140-6736(20)31103-X
Feldstein, L. R., Rose, E. B., Horwitz, S. M., Collins, J. P., Newhams, M. M., Son, M. B. F., Newburger, J. W., Kleinman, L. C., Heidemann, S. M., Martin, A. A., Singh, A. R., Li, S., Tarquinio, K. M., Jaggi, P., Oster, M. E., Zackai, S. P., Gillen, J., Ratner, A. J., Walsh, R. F., Fitzgerald, J. C., … CDC COVID-19 Response Team (2020). Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. The New England journal of medicine, 383(4), 334-346. https://doi.org/10.1056/NEJMoa2021680
Patel, J. M. (2022). Multisystem Inflammatory Syndrome in Children (MIS-C). Current allergy and asthma reports, 22(5), 53-60. https://doi.org/10.1007/s11882-022-01031-4
Kaushik, A., Gupta, S., Sood, M., Sharma, S., & Verma, S. (2020). A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. The Pediatric infectious disease journal, 39(11), e340-e346. https://doi.org/10.1097/INF.0000000000002888
Carter, M. J., Fish, M., Jennings, A., Doores, K. J., Wellman, P., Seow, J., Acors, S., Graham, C., Timms, E., Kenny, J., Neil, S., Malim, M. H., Tibby, S. M., & Shankar-Hari, M. (2020). Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Nature medicine, 26(11), 1701-1707. https://doi.org/10.1038/s41591-020-1054-6
Center for Disease Control and Prevention. (2023, January 3). Multisystem inflammatory syndrome in children (MIS-C). https://www.cdc.gov/mis/mis-c.html
Doğan, A., Güngör, Ş., Güllü, U. U., İpek, S., Yurttutan, N., & Yurttutan, S. (2022). Evaluation of thymic dimensions in patients with multisystem inflammatory syndrome. The Turkish journal of pediatrics, 64(6), 1058-1067. https://doi.org/10.24953/turkjped.2022.451
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