Makiello Phoebe, Svirpliene Sima, Finlay Lisa, McKnight Jean
Department of Paediatrics, Dumfries and Galloway Royal Infirmary, Dumfries, UK
Department of Paediatrics, Dumfries and Galloway Royal Infirmary, Dumfries, UK.
BMJ Case Rep. 2020 Dec 9;13(12):e238531. doi: 10.1136/bcr-2020-238531.
An 11-year-old boy presented with features resembling those described in health alerts on Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), including persistent fever, haemodynamic instability and abdominal pain. Laboratory tests, including raised inflammatory markers, D-dimer, troponin and a coagulopathy, were consistent with PIMS-TS. Our patient required transfer to the paediatric intensive care unit; an echocardiography revealed left ventricular dysfunction. He was treated with intravenous immunoglobulins (Igs), corticosteroids and aspirin, with full resolution of clinical symptoms. A follow-up echocardiogram 1 month after discharge was unremarkable.Three SARS-CoV-2 PCRs on respiratory samples, taken over the initial 4-day period, were negative, as was a SARS-CoV-2 PCR on faeces 1 month after presentation; titres of IgG were clearly elevated. The negative PCRs in the presence of elevated titres of IgG suggest that the inflammatory syndrome might have developed in a late phase of COVID-19 infection when the virus was no longer detectable in the upper airway.
一名11岁男孩出现了一些类似于儿童炎症性多系统综合征（与SARS-CoV-2暂时相关，PIMS-TS）健康警报中所描述的特征，包括持续发热、血流动力学不稳定和腹痛。实验室检查，包括炎症标志物升高、D-二聚体、肌钙蛋白和凝血障碍，与PIMS-TS相符。我们的患者需要转至儿科重症监护病房；超声心动图显示左心室功能障碍。他接受了静脉注射免疫球蛋白（Ig）、皮质类固醇和阿司匹林治疗，临床症状完全缓解。出院1个月后的随访超声心动图无异常。在最初4天内采集的呼吸道样本进行的三次SARS-CoV-2 PCR检测均为阴性，就诊1个月后粪便的SARS-CoV-2 PCR检测也为阴性；IgG滴度明显升高。IgG滴度升高而PCR检测呈阴性表明，炎症综合征可能在COVID-19感染的晚期出现，此时在上呼吸道已无法检测到病毒。
