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Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19 Due to SARS-CoV-2.
Am J Case Rep. 2020 Aug 13; 21:e925779.AJ

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. CASE REPORT Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorporeal membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered.

CONCLUSIONS

Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO.

Authors+Show Affiliations

Children's Hospital of Michigan, Detroit, MI, USA. Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA.Children's Hospital of Michigan, Detroit, MI, USA. Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA.Children's Hospital of Michigan, Detroit, MI, USA. Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA.Children's Hospital of Michigan, Detroit, MI, USA.Children's Hospital of Michigan, Detroit, MI, USA. Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA.Children's Hospital of Michigan, Detroit, MI, USA. Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA.Children's Hospital of Michigan, Detroit, MI, USA. Department of Pediatrics, Wayne State University, Detroit, MI, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32790652

Citation

Heidemann, Sabrina M., et al. "Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 Due to SARS-CoV-2." The American Journal of Case Reports, vol. 21, 2020, pp. e925779.
Heidemann SM, Tilford B, Bauerfeld C, et al. Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19 Due to SARS-CoV-2. Am J Case Rep. 2020;21:e925779.
Heidemann, S. M., Tilford, B., Bauerfeld, C., Martin, A., Garcia, R. U., Yagiela, L., & Sarnaik, A. P. (2020). Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19 Due to SARS-CoV-2. The American Journal of Case Reports, 21, e925779. https://doi.org/10.12659/AJCR.925779
Heidemann SM, et al. Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 Due to SARS-CoV-2. Am J Case Rep. 2020 Aug 13;21:e925779. PubMed PMID: 32790652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19 Due to SARS-CoV-2. AU - Heidemann,Sabrina M, AU - Tilford,Bradley, AU - Bauerfeld,Christian, AU - Martin,Amarilis, AU - Garcia,Richard U, AU - Yagiela,Lauren, AU - Sarnaik,Ashok P, Y1 - 2020/08/13/ PY - 2020/8/14/entrez PY - 2020/8/14/pubmed PY - 2020/9/2/medline SP - e925779 EP - e925779 JF - The American journal of case reports JO - Am J Case Rep VL - 21 N2 - BACKGROUND Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. CASE REPORT Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorporeal membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered. CONCLUSIONS Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/32790652/Three_Cases_of_Pediatric_Multisystem_Inflammatory_Syndrome_Associated_with_COVID_19_Due_to_SARS_CoV_2_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32790652/ DB - PRIME DP - Unbound Medicine ER -