Manchola Narváez Karen Daniela, Ortíz Natalia Del Pilar Delgado, Ardila Gómez Iván José, López Pilar Pérez, Rivera Ortíz Martín Fernando
Pediatric Resident, Surcolombiana University, Hospital Universitario de Neiva, Neiva Huila, Colombia.
Ivan Jose Ardila Gomez, Pediatric Critical Care, Clínica Uros, Hospital Universitario de Neiva, Surcolombiana University, Neiva-Huila, Colombia.
Case Rep Med. 2022 Sep 28;2022:3785103. doi: 10.1155/2022/3785103. eCollection 2022.
Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious condition which usually develops 4 to 6 weeks after SARS-CoV-2 infection in a genetically predisposed individual. Clinical features are heterogeneous and include fever, respiratory compromise, mucocutaneous involvement with conjunctival abnormalities and erythematous exanthem, abdominal pain, and diarrhea. Neurologic and cardiovascular symptoms can also develop, including coronary artery dilatation. Some cases involve 2 or more organs and require critical admission. Echocardiography is the mainstay of cardiac evaluation in the acute setting as well as on outpatient follow-up. We present the case of a 4-month-old female with no past medical or surgical history who presented with a prolonged febrile syndrome associated with severe respiratory illness, gastrointestinal symptoms, and mucocutaneous abnormalities. Diagnosis of MIS-C was established based on clinical findings, persistently elevated markers of systemic inflammation and positive SARS-CoV-2 molecular test and evidence of prior SARS-CoV-2 infection with SARS-CoV-2 IgG positive. Echocardiogram evidenced myopericarditis and coronary aneurysms and patient was deemed candidate for immunomodulatory therapy with intravenous immunoglobulin (IVIg), resulting in favorable clinical and paraclinical outcomes. Few cases of giant coronary aneurysms have been reported in children. There are no existing literature reports about coronary thrombosis or thrombus formation resulting from vascular aneurysmal dilations in this population. As such, the prognosis and natural history of coronary artery aneurysms in the setting of MIS-C remain largely unknown.
儿童多系统炎症综合征（MIS-C）是一种感染后疾病，通常在具有遗传易感性的个体感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后4至6周出现。临床特征多种多样，包括发热、呼吸功能不全、伴有结膜异常和红斑性皮疹的皮肤黏膜受累、腹痛和腹泻。还可能出现神经和心血管症状，包括冠状动脉扩张。一些病例累及两个或更多器官，需要重症监护入院。超声心动图是急性情况下以及门诊随访时心脏评估的主要手段。我们报告一例4个月大的女性病例，她既往无内科或外科病史，因伴有严重呼吸道疾病、胃肠道症状和皮肤黏膜异常的持续性发热综合征就诊。根据临床发现、全身炎症标志物持续升高、SARS-CoV-2分子检测阳性以及SARS-CoV-2 IgG阳性证明既往感染SARS-CoV-2，确诊为MIS-C。超声心动图显示心肌心包炎和冠状动脉瘤，患者被认为是静脉注射免疫球蛋白（IVIg）免疫调节治疗的候选者，治疗后临床和辅助检查结果良好。儿童中报道的巨大冠状动脉瘤病例很少。目前尚无关于该人群中血管动脉瘤扩张导致冠状动脉血栓形成或血栓的文献报道。因此，MIS-C背景下冠状动脉瘤的预后和自然史在很大程度上仍不清楚。
