Navaeifar Mohammad Reza, Shahbaznejad Leila, Sadeghi Lotfabadi Ali, Rezai Mohammad Sadegh
Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Pediatrics, BuAli Sina Hospital, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Case Rep Pediatr. 2021 Jan 6;2021:8836403. doi: 10.1155/2021/8836403. eCollection 2021.
In the early stages of the outbreak of the novel coronavirus disease 2019 (COVID-19), it was assumed that this infection is very mild and uncommon in children. However, recent reports have shown that children may also develop the disease and its severe complications. These complications included shock, multisystem inflammatory syndrome in children (MIS-C), and pneumonia in children. A previously healthy 14-month-old boy presented with fever, irritability, and skin rash, besides changes in the lips, conjunctiva, and tongue. His medical history, clinical presentations, treatment, laboratory data, and follow-up information were recorded. He was treated according to the diagnosis of Kawasaki disease (KD). He had a history of close contact with a COVID-19 patient. However, the result of reverse transcription-polymerase chain reaction (RT-PCR) assay for COVID-19 was negative. Immunoglobulin M for COVID-19 was positive (1.20), while immunoglobulin G was negative (0.37). Three weeks later, seroconversion of COVID-19 immunoglobulin G (1.42) occurred. Despite treatment with two doses of intravenous immunoglobulin and methylprednisolone, coronary artery ectasia was detected. On the sixth day of hospitalization, the patient experienced hypotension, which necessitated treatment with inotropic drugs and resulted in a change of diagnosis to MIS-C. The later echocardiography showed evidence of coronary artery aneurysm (CAA), which finally changed to giant CAA. Although the patient was treated with infliximab, the size of CAA showed a significant decrease in the one-month follow-up. This is the first report of MIS-C during the COVID-19 pandemic in Iran, accompanied by KD, which was complicated with giant CAA.
在2019年新型冠状病毒病（COVID-19）疫情爆发的早期阶段，人们认为这种感染在儿童中非常轻微且不常见。然而，最近的报告显示儿童也可能感染该疾病并出现严重并发症。这些并发症包括休克、儿童多系统炎症综合征（MIS-C）和儿童肺炎。一名此前健康的14个月大男孩出现发热、烦躁和皮疹，同时伴有嘴唇、结膜和舌头的变化。记录了他的病史、临床表现、治疗情况、实验室数据和随访信息。他被按照川崎病（KD）的诊断进行治疗。他有与一名COVID-19患者密切接触的病史。然而，COVID-19的逆转录聚合酶链反应（RT-PCR）检测结果为阴性。COVID-19免疫球蛋白M呈阳性（1.20），而免疫球蛋白G呈阴性（0.37）。三周后，出现了COVID-19免疫球蛋白G的血清学转换（1.42）。尽管接受了两剂静脉注射免疫球蛋白和甲泼尼龙治疗，但仍检测到冠状动脉扩张。住院第六天，患者出现低血压，需要使用强心药物治疗，诊断也因此改为MIS-C。后来的超声心动图显示有冠状动脉瘤（CAA）的迹象，最终发展为巨大冠状动脉瘤。尽管患者接受了英夫利昔单抗治疗，但在一个月的随访中CAA的大小显著减小。这是伊朗COVID-19大流行期间伴有KD并并发巨大冠状动脉瘤的MIS-C的首例报告。
