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- Title
CARDIOVASCULAR INVOLVEMENT IN MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C): A CASE REPORT WITH EXTENSIVE VASCULITIS IN MIS-C.
- Authors
Suteu, Nicola; Tanase, Mara; Robu, Răzvan; Suteu, Carmen Corina
- Abstract
Introduction: Multisystem Inflammatory Syndrome of Children (MIS-C) is a new disease defined post-viral myocarditis and inflammatory vasculopathy of children following COVID-19 infection. Case Report: We report a case of 13-year-old male with MIS-C presented with cardiac manifestations associated with extensive vasculitis. The child was transferred from an outside institution to the emergency department of our tertiary center with a 2- weeks history of generalized weakness, prolonged fever, rash, conjunctivitis, abdominal pain, limping, left shoulder pain, palpations. On presentation, the patient was ill looking with tachycardia, cardiac gallop with III/VI regurgitant murmur at the apex, decreased lower extremities pulses, hepato-splenomegaly. Inflammatory and procoagulant tests (C-reactive protein, ferritin, interleukin-6, fibrinogen, D-dimer), cardiac biomarkers (troponin I, NT-proBNP) were elevated. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Laboratory workup have ruled out infectious and malignant causes as well as known rheumatological causes. Echocardiography pointed out LV systolic dysfunction (LVEF 46%), apical septal hypokinesia, moderate mitral valve regurgitation, coronary arteries dilatation. Doppler ultrasound and CT scan showed evidence of vasculitis extending to the abdominal organs with splenic and renal infarcts, and evidence of dorsalis pedis arteritis. According to WHO criteria the patient's diagnosis was MIS-C. Treatment was started immediately with intravenous immunoglobulin, methylprednisolone, anticoagulants, in addition to angiotensin converting enzyme inhibitors, beta-blockers, spironolactone, with outstanding favorable evolution. After a 36-day hospital stay, the patient was discharged home in stable condition with further medical management. Discussions : MIS-C is a new emerging medical diagnosis that occurs in response to a SARS-CoV-2 infection. It has a variable presentation. This pathological condition is described a Kawasaki-like syndrome that affects small to medium vessels. This teenage patient presented with prolonged fever, elevated inflammatory markers and manifested multiorgan involvement as well as a positive serology test for recent SARS-CoV-2 infection, meeting the WHO criteria to diagnose MIS-C. Distinct features of MIS-C manifested in this case include predominance of gastrointestinal symptoms manifested as severe abdominal pain, and cardiovascular symptoms presented as palpitations, left shoulder pain and limping. Because MIS-C could be a life-threatening multisystem condition, treatment options are needed urgently. The aim of MIS-C treatment is to suppress systemic inflammation, improve cardiac function, and prevent long-term sequelae. Conclusions: The phenotype of MIS-C associated with SARSCoV-2 infection may include an extensive large-vessel vasculitis. Early recognition and diagnosis of this rare presentation will raise knowledge about the nature of vascular complications associated with MIS-C.
- Subjects
ROMANIA; VASCULITIS; CONFERENCES &; conventions; MULTISYSTEM inflammatory syndrome; SYMPTOMS; ADOLESCENCE
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p249
- ISSN
2668-7755
- Publication type
Article