Cardiological Monitoring – A Cornerstone for Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 Outcome: A Case Report and a Review from the Literature
Article Category: Case Report
Online veröffentlicht: 12. Nov. 2022
Seitenbereich: 273 - 278
Eingereicht: 27. Okt. 2021
Akzeptiert: 30. Aug. 2022
DOI: https://doi.org/10.2478/jccm-2022-0022
Schlüsselwörter
© 2022 Lorena Elena Melit, Oana Marginean, Tudor Fleșeriu, Alina Negrea, Maria Oana Săsăran, Simina Ghiraghosian-Rusu, Andrei Călin Dragomir, Mirela Oiaga, Carmen Șuteu, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Introduction
Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a rare life-threatening condition requiring a complex management and multidisciplinary approach, whose outcome depends on the early diagnosis.
Case report
We report the case of a 2 years and-5-month-old boy admitted in our clinic for fever, abdominal pain and diarrhea. The clinical exam at the time of admission revealed influenced gen-eral status, bilateral palpebral edema and conjunctivitis, mucocutaneous signs of dehydration, and abdominal tenderness at palpation. The laboratory tests performed pointed out lymphopenia, thrombocytopenia, anemia, elevated C-reactive protein – CRP, erythrocyte sedimentation rate and ferritin levels, hyponatremia, hypopotassemia, hypertriglyceridemia, elevated D-dimer, in-creased troponin and NT-proBNP. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Thus, established the diagnosis of PIMS-TS. We initiated intravenous immunoglobulin, empirical antibiotic, anticoagulation therapy and symptomatic drugs. Nevertheless, the clinical course and laboratory parameters worsened, and the 2nd echocardiography pointed out minimal pericardial effusion, slight dilation of the left cavities, dyskinesia of the inferior and septal basal segments of the left ventricle (LV), and LV systolic dysfunction. Therefore, we associated intravenous methylprednisolone, angiotensin converting enzyme inhibitors, spironolactone and hydrochlorothiazide, with outstanding favorable evolution.
Conclusions
Echocardiographic monitoring might be a lifesaving diagnostic tool in the management of PIMS-TS.