Cirks Blake T, Geracht Jennifer C, Jones Olcay Y, May Joseph W, Mikita Cecilia P, Rajnik Michael, Helfrich Alison M
Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Department of Allergy/Immunology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Mil Med. 2021 Jan 30;186(1-2):e270-e276. doi: 10.1093/milmed/usaa508.
The novel human coronavirus of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly swept throughout the entire world. As the ongoing pandemic has spread, recent studies have described children presenting with a multisystem inflammatory disorder sharing the features of Kawasaki disease (KD) and toxic shock syndrome, now named Multisystem Inflammatory Syndrome in Children (MIS-C). These cases report a similar phenotype of prolonged fever, multisystem involvement, and biomarkers demonstrating marked hyperinflammation that occurs temporally in association with local community spread of SARS-CoV-2. Herein, we describe the presentation, clinical characteristics, and management of an 11-year-old boy with prolonged fever, strikingly elevated inflammatory markers, and profound, early coronary artery aneurysm consistent with a hyperinflammatory, multisystem disease temporally associated with coronavirus disease 2019. We highlight our multidisciplinary team's management with intravenous immunoglobulin, methylprednisolone, and an interleukin-1 receptor antagonist, anakinra, as a strategy to manage this multisystem, hyperinflammatory disease process.
2019年新型人类冠状病毒，即严重急性呼吸综合征冠状病毒2（SARS-CoV-2），已迅速席卷全球。随着这场持续的大流行的蔓延，最近的研究描述了一些儿童出现了一种多系统炎症性疾病，其具有川崎病（KD）和中毒性休克综合征的特征，现被命名为儿童多系统炎症综合征（MIS-C）。这些病例报告了一种相似的表型，即持续发热、多系统受累，以及生物标志物显示出明显的炎症反应过度，这种情况在时间上与SARS-CoV-2在当地社区的传播相关。在此，我们描述了一名11岁男孩的临床表现、临床特征及治疗情况，该男孩持续发热，炎症标志物显著升高，且早期出现严重的冠状动脉瘤，符合一种与2019冠状病毒病在时间上相关的炎症反应过度的多系统疾病。我们强调了我们多学科团队采用静脉注射免疫球蛋白、甲泼尼龙和白细胞介素-1受体拮抗剂阿那白滞素进行治疗的策略，以此来应对这种多系统、炎症反应过度的疾病进程。
