Bottari Gabriella, Confalone Valerio, Cotugno Nicola, Guzzo Isabella, Perdichizzi Salvatore, Manno Emma C, Stoppa Francesca, Cecchetti Corrado
Pediatric Emergency Department Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy.
Clinical Immunology and Vaccinology Unit, Pediatric Academic Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy.
Front Pediatr. 2021 Jun 11;9:676298. doi: 10.3389/fped.2021.676298. eCollection 2021.
Multisystem inflammatory syndrome in children (MIS-C) has emerged during the COVID-19 pandemic as a new SARS-CoV-2-related entity, potentially responsible for a life-threatening clinical condition associated with myocardial dysfunction and refractory shock. We describe for the first time in a 14-year-old girl with severe MIS-C the potential benefit of an adjuvant therapy based on CytoSorb hemoperfusion and continuous renal replacement therapy with immunomodulatory drugs. We show in our case that, from the start of extracorporeal blood purification, there was a rapid and progressive restoration in cardiac function and hemodynamic parameters in association with a reduction in the most important inflammatory biomarkers (interleukin 6, interleukin 10, C-reactive protein, ferritin, and D-dimers). Additionally, for the first time, we were able to show with analysis of the sublingual microcirculation a delayed improvement in most of the important microcirculation parameters in this clinical case of MIS-C.
儿童多系统炎症综合征(MIS-C)在新冠疫情期间作为一种与新型严重急性呼吸综合征冠状病毒2(SARS-CoV-2)相关的新病症出现,可能导致与心肌功能障碍和难治性休克相关的危及生命的临床状况。我们首次描述了在一名患有严重MIS-C的14岁女孩中,基于CytoSorb血液灌流和使用免疫调节药物的持续肾脏替代疗法的辅助治疗的潜在益处。我们在病例中表明,从开始体外血液净化起,心脏功能和血流动力学参数迅速且逐步恢复,同时最重要的炎症生物标志物(白细胞介素6、白细胞介素10、C反应蛋白、铁蛋白和D-二聚体)减少。此外,首次通过舌下微循环分析,我们能够证明在该MIS-C临床病例中,大多数重要微循环参数有延迟改善。