Cardiovascular complications of COVID-associated multisystem inflammatory syndrome in an infant: A case report

Abstract

Multisystem inflammatory syndrome is an extremely severe form of coronavirus infection in children, which characterized by systemic hyperinflammation with multiple organ failure. In some cases, cardiovascular complications are reported, including myocardial dysfunction, myocardial ischemia, shock, arrhythmias, coronaritis and coronary artery aneurysms. Although the incidence of coronavirus infection has decreased, patient mortality from multisystem inflammatory syndrome remains high. A clinical case of COVID-associated multisystem inflammatory syndrome in an infant is presented. Since admission, the patient with a high titer of immunoglobulin G with SARS-CoV-2 showed signs of hyperinflammation with subsequent development of pericarditis and myocardial dysfunction associated with prolonged bilateral pneumonia. Coronaritis and aneurysm of the left coronary artery were diagnosed. The patient had a long history of reduced global contractile function and high levels of myocardial damage markers requiring prolonged inotropic support and use of cardiac glycosides. Later, paroxysmal tachycardia developed in addition to cardiovascular complications. Comprehensive management of the disease and early detection of complications resulted in a favorable outcome.

Keywords

COVID-associated multisystem inflammatory syndrome / cardiovascular failure / Kawasaki-like syndrome / COVID-19 / children / infancy / clinical case

References

[1] Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. E Clin Med. 2020;26:100527. doi: 10.1016/j.eclinm.2020

[2] Ahmed M., Advani S., Moreira A., et al. Multisystem inflammatory syndrome in children: A systematic review // E Clin Med. 2020. Vol. 26. ID 100527. doi: 10.1016/j.eclinm.2020

[3] Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. E Clin Med. 2020;26:100527. doi: 10.1016/j.eclinm.2020

[4] Harwood R, Allin B, Jones CE, et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Health. 2021;5(2):133–141. doi: 10.1016/S2352-4642(20)30304-7

[5] Harwood R., Allin B., Jones C.E., et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process // Lancet Child Adolesc Health. 2021. Vol. 5, N 2. P. 133–141. doi: 10.1016/S2352-4642(20)30304-7

[6] Harwood R, Allin B, Jones CE, et al. A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc Health. 2021;5(2):133–141. doi: 10.1016/S2352-4642(20)30304-7

[7] archive.cdc.gov [Internet]. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) [cited 16 Nov 2024]. Available from: https://archive.cdc.gov/#/details?url=https://emergency.cdc.gov/han/2020/han00432.asp

[8] archive.cdc.gov [Электронный ресурс]. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) [дата обращения: 16.11.2024]. Режим доступа: https://archive.cdc.gov/#/details?url=https://emergency.cdc.gov/han/2020/han00432.asp

[9] archive.cdc.gov [Internet]. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) [cited 16 Nov 2024]. Available from: https://archive.cdc.gov/#/details?url=https://emergency.cdc.gov/han/2020/han00432.asp

[10] Galeotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020;16(8):413–414. doi: 10.1038/s41584-020-0448-7

[11] Galeotti C., Bayry J. Autoimmune and inflammatory diseases following COVID-19 // Nat Rev Rheumatol. 2020. Vol. 16, N 8. P. 413–414. doi: 10.1038/s41584-020-0448-7

[12] Galeotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020;16(8):413–414. doi: 10.1038/s41584-020-0448-7

[13] Howard-Jones AR, Burgner DP, Crawford NW, et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022;58(1):46–53. doi: 10.1111/jpc.15811

[14] Howard-Jones A.R., Burgner D.P., Crawford N.W., et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management // J Paediatr Child Health. 2022. Vol. 58, N 1. P. 46–53. doi: 10.1111/jpc.15811

[15] Howard-Jones AR, Burgner DP, Crawford NW, et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022;58(1):46–53. doi: 10.1111/jpc.15811

[16] Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:2094. doi: 10.1136/bmj.m2094

[17] Toubiana J., Poirault C., Corsia A., et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study // BMJ. 2020. Vol. 369. ID 2094. doi: 10.1136/bmj.m2094

[18] Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:2094. doi: 10.1136/bmj.m2094

[19] Waseem M, Shariff MA, Tay ET, et al. Multisystem inflammatory syndrome in children. J Emerg Med. 2022;62(1):28–37. doi: 10.1016/j.jemermed.2021.07.070

[20] Waseem M., Shariff M.A., Tay E.T., et al. Multisystem inflammatory syndrome in children // J Emerg Med. 2022. Vol. 62, N 1. P. 28–37. doi: 10.1016/j.jemermed.2021.07.070

[21] Waseem M, Shariff MA, Tay ET, et al. Multisystem inflammatory syndrome in children. J Emerg Med. 2022;62(1):28–37. doi: 10.1016/j.jemermed.2021.07.070

[22] www.who.int [Internet]. Multisystem inflammatory syndrome in children and adolescents with COVID-19 [cited 16 Nov 2024]. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

[23] www.who.int [Электронный ресурс]. Multisystem inflammatory syndrome in children and adolescents with COVID-19 [дата обращения: 16.11.2024]. Режим доступа: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

[24] www.who.int [Internet]. Multisystem inflammatory syndrome in children and adolescents with COVID-19 [cited 16 Nov 2024]. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

[25] Cantarutti N, Battista V, Adorisio R, et al. Cardiac manifestations in children with SARS-CоV-2 infection: 1-year pediatric multicenter experience. Children (Basel). 2021;8(8):717. doi: 0.3390/children8080717

[26] Cantarutti N., Battista V., Adorisio R., et al. Cardiac manifestations in children with SARS-CoV-2 infection: 1-year pediatric multicenter experience // Children (Basel). 2021. Vol. 8, N 8. ID 717. doi: 0.3390/children8080717

[27] Cantarutti N, Battista V, Adorisio R, et al. Cardiac manifestations in children with SARS-CоV-2 infection: 1-year pediatric multicenter experience. Children (Basel). 2021;8(8):717. doi: 0.3390/children8080717

[28] Alexandrovich YuS, Alekseeva EI, Bakradze MD, et al. Clinical features and management of the disease caused by new coronaviral infection (COVID-19) in children. Version 2. Pediatric pharmacology. 2020;17(3):187–212. EDN: FQGJXK doi: 10.15690/pf.v17i3.2123

[29] Александрович Ю.С., Алексеева Е.И., Бакрадзе М.Д., и др. Особенности клинических проявлений и лечения заболевания, вызванного новой коронавирусной инфекцией (COVID-19), у детей. Версия 2 // Педиатрическая фармакология. 2020. Т. 17, № 3. С. 187–212. EDN: FQGJXK doi: 10.15690/pf.v17i3.2123

[30] Alexandrovich YuS, Alekseeva EI, Bakradze MD, et al. Clinical features and management of the disease caused by new coronaviral infection (COVID-19) in children. Version 2. Pediatric pharmacology. 2020;17(3):187–212. EDN: FQGJXK doi: 10.15690/pf.v17i3.2123

[31] Malviya A, Mishra A. Childhood multisystem inflammatory syndrome: an emerging disease with prominent cardiovascular involvement — a scoping review. SN Compr Clin Med. 2021;3(1):48–59. doi: 10.1007/s42399-020-00650-0

[32] Malviya A., Mishra A. Childhood multisystem inflammatory syndrome: an emerging disease with prominent cardiovascular involvement — a scoping review // SN Compr Clin Med. 2021. Vol. 3, N 1. P. 48–59. doi: 10.1007/s42399-020-00650-0

[33] Malviya A, Mishra A. Childhood multisystem inflammatory syndrome: an emerging disease with prominent cardiovascular involvement — a scoping review. SN Compr Clin Med. 2021;3(1):48–59. doi: 10.1007/s42399-020-00650-0

[34] Patel JM. Multisystem inflammatory syndrome in children (MIS-C). Curr Allergy Asthma Rep. 2022;22(5):53–60. doi: 10.1007/s11882-022-01031-4

[35] Patel J.M. Multisystem inflammatory syndrome in children (MIS-C) // Curr Allergy Asthma Rep. 2022. Vol. 22, N 5. P. 53–60. doi: 10.1007/s11882-022-01031-4

[36] Patel JM. Multisystem inflammatory syndrome in children (MIS-C). Curr Allergy Asthma Rep. 2022;22(5):53–60. doi: 10.1007/s11882-022-01031-4

[37] McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis — a critical review of its pathogenesis and treatment. Front Pediatr. 2020;8:626182. doi: 10.3389/fped.2020.626182

[38] McMurray J.C., May J.W., Cunningham M.W., Jones O.Y. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis — a critical review of its pathogenesis and treatment // Front Pediatr. 2020. Vol. 8. ID 626182. doi: 10.3389/fped.2020.626182

[39] McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis — a critical review of its pathogenesis and treatment. Front Pediatr. 2020;8:626182. doi: 10.3389/fped.2020.626182

[40] Dionne A, Son MBF, Randolph AG. An update on multisystem inflammatory syndrome in children related to SARS-CoV-2. Pediatr Infect Dis J. 2022;41(1):6–9. doi: 10.1097/INF.0000000000003393

[41] Dionne A., Son M.B.F., Randolph A.G. An update on multisystem inflammatory syndrome in children related to SARS-CoV-2 // Pediatr Infect Dis J. 2022. Vol. 41, N 1. P. 6–9. doi: 10.1097/INF.0000000000003393

[42] Dionne A, Son MBF, Randolph AG. An update on multisystem inflammatory syndrome in children related to SARS-CoV-2. Pediatr Infect Dis J. 2022;41(1):6–9. doi: 10.1097/INF.0000000000003393

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