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Int J Infect Dis ; 106: 405-408, 2021 May.
Article in English | MEDLINE | ID: covidwho-1188640


OBJECTIVES: Multi-system inflammatory syndrome in children (MIS-C) is a post-viral inflammatory vasculopathy of children and adolescents following Covid-19 infection. Since the incidence of SARS-CoV-infections has been increasing in Germany since October 2020, we observe an increasing number of children presenting with MIS-C. DESIGN: We present detailed clinical characteristics of a cohort of nine children with MIS-C admitted to a tertiary PICU at the University Hospital of Cologne between March 2020 and February 2021. RESULTS: The clinical sings and symptoms are largely in line with recent reports. All but one patient had positive SARS-CoV-2 antibodies. Latency form infection to MIS-C was 4-6 weeks. Two children presented with unusual findings: A girl had encephalomyelitis and a boy developed MIS-C side to side with acute leukemia. CONCLUSION: MIS-C has been increasing in Germany paralell to SARS-CoV-2 infections. Rarely, unuasual findings may be associated with MIS-C.

COVID-19/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Abnormalities, Multiple , Adolescent , COVID-19/complications , COVID-19/therapy , Child , Cohort Studies , Female , Genetic Diseases, X-Linked/complications , Germany , Hospitalization , Humans , Ichthyosiform Erythroderma, Congenital/complications , Infant , Limb Deformities, Congenital/complications , Male , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/therapy
Pediatrics ; 147(2)2021 02.
Article in English | MEDLINE | ID: covidwho-839329


This is a novel case of a 16-month-old boy with a history of prematurity with intrauterine growth restriction, severe failure to thrive, microcephaly, pachygyria, agenesis of the corpus callosum, and postnatal embolic stroke, who presented with new-onset diabetes mellitus with diabetic ketoacidosis in the setting of severe acute respiratory syndrome coronavirus 2 infection, with a course complicated by atypical hemolytic syndrome (aHUS). This patient demonstrated remarkable insulin resistance in the period before aHUS diagnosis, which resolved with the first dose of eculizumab therapy. There is increasing evidence that COVID-19 is associated with thrombotic disorders and that microangiopathic processes and complement-mediated inflammation may be implicated. In this case report, we describe a pediatric patient with COVID-19 and a new complement-mediated microangiopathic thrombotic disease. Because whole-exome sequencing and extensive workup returned without a clear etiology for aHUS, this is likely a COVID-19 triggered case of aHUS versus an idiopathic case that was unmasked by the infection.

Atypical Hemolytic Uremic Syndrome/diagnosis , Atypical Hemolytic Uremic Syndrome/etiology , COVID-19/complications , Diabetes Mellitus, Type 1/diagnosis , Diabetic Ketoacidosis/diagnosis , Abnormalities, Multiple , Antibodies, Monoclonal, Humanized/therapeutic use , Atypical Hemolytic Uremic Syndrome/drug therapy , COVID-19/diagnosis , Child, Preschool , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Humans , Infant, Premature , Insulin Resistance , Male , Risk Factors , SARS-CoV-2
J Pediatr Gastroenterol Nutr ; 71(2): 153-155, 2020 08.
Article in English | MEDLINE | ID: covidwho-729245


Coronavirus disease 2019 (COVID-19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID-19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor-alpha (TNF-α) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS-CoV-2 polymerase chain reaction was positive. Despite inpatient treatment for COVID-19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid-refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)-6, IL-8, and TNF-α, higher than those described in either inflammatory bowel disease or severe COVID-19 alone. The patient was treated with infliximab for TNF-α blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID-19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF-α, a decrease in IL-6, and IL-8 concentrations. This case supports a role for blockade of TNF-α in the treatment of COVID-19 inflammatory cascade. The role of anti-TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID-19 requires further investigation.

Coronavirus Infections/drug therapy , Crohn Disease/complications , Genetic Diseases, X-Linked/complications , Ichthyosiform Erythroderma, Congenital/complications , Infliximab/therapeutic use , Interleukin-6/blood , Interleukin-8/blood , Limb Deformities, Congenital/complications , Pneumonia, Viral/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Abnormalities, Multiple , Adolescent , Antirheumatic Agents/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Humans , Male , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2 , Tumor Necrosis Factor-alpha/blood