Parappil Parvathi, Ghimire Sushant, Saxena Apoorv, Mukherjee Sweta, John B M, Sondhi Vishal, Sengupta P, Acharya Suchi
Department of Pediatrics, AFMC, Pune, India.
Department of Pediatrics, Command Hospital (SC), Pune, India.
Infect Dis (Lond). 2022 Jul;54(7):522-528. doi: 10.1080/23744235.2022.2050423. Epub 2022 Mar 17.
Coronavirus disease 2019 (COVID 19) usually causes a mild illness among children. However, in a minority of children, it may be associated with the life-threatening multisystem inflammatory syndrome (MIS-C), or thrombotic microangiopathy, or sequelae like type-1 diabetes mellitus (T1DM). We describe a previously healthy, 12-year-old boy with new-onset T1DM with diabetic ketoacidosis (DKA) in the setting of MIS-C, with a course complicated by thrombotic microangiopathy.
The patient presented with four days history of fever, non-bilious vomiting, polyuria and polydipsia. On evaluation, he was noted to have diabetic ketoacidosis. Although Diabetic ketoacidosis with insulin and intravenous fluids, his hospital course was notable for shock requiring vasopressor, purpura fulminans with eschar formation, neurological manifestations (left hemiparesis due to right middle cerebral artery territory infarct, mononeuritis multiplex) and thrombotic microangiopathy. MIS-C-like illness secondary to COVID-19 was suspected due to diabetic ketoacidosis, thrombotic microangiopathy, elevated inflammatory markers, history of contact with COVID-19-infected individual and detectable COVID-19 IgG antibodies. He improved following management with methylprednisolone, intravenous immunoglobulin, low-molecular-weight heparin and aspirin, and was discharged on hospital day 48.
MIS-C-like illness should be considered in children and adolescents presenting with complex multisystem involvement in this era of COVID 19. Management with immunomodulatory agents can be lifesaving.
2019年冠状病毒病（COVID-19）通常在儿童中引起轻症。然而，在少数儿童中，它可能与危及生命的多系统炎症综合征（MIS-C）、血栓性微血管病或1型糖尿病（T1DM）等后遗症有关。我们描述了一名既往健康的12岁男孩，在MIS-C背景下新发T1DM并伴有糖尿病酮症酸中毒（DKA），病程并发血栓性微血管病。
患者出现发热、非胆汁性呕吐、多尿和多饮4天病史。评估时，发现他患有糖尿病酮症酸中毒。尽管通过胰岛素和静脉补液治疗糖尿病酮症酸中毒，但他的住院病程以需要血管活性药物的休克、伴有焦痂形成的暴发性紫癜、神经学表现（右侧大脑中动脉区域梗死导致左侧偏瘫、多发性单神经炎）和血栓性微血管病为显著特征。由于糖尿病酮症酸中毒、血栓性微血管病、炎症标志物升高、与COVID-19感染者接触史以及可检测到的COVID-19 IgG抗体，怀疑是继发于COVID-19的MIS-C样疾病。在接受甲泼尼龙、静脉注射免疫球蛋白、低分子量肝素和阿司匹林治疗后病情好转，并于住院第48天出院。
在COVID-19这个时代，对于出现复杂多系统受累的儿童和青少年，应考虑MIS-C样疾病。使用免疫调节剂治疗可能挽救生命。
