RESUMEN
A SARS-CoV-2 infection is usually characterized by a very mild clinical course in the pediatric population. However, children can be severely affected, and clinical manifestations may differ from adults, mainly in terms of post-COVID-19 infection complications already known as multisystem inflammatory syndrome in children (MIS-C). As the name suggests, this condition involves many systems, including the cardiovascular system, clinical manifestations of which include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. This research aims to define the cardiac manifestations caused by multi-inflammatory processes occurring after acute SARS-CoV-2 infection, possibly find a correlation between a certain cardiac abnormality and inflammatory markers, and evaluate the dynamics of cardiovascular complications and how treatment affects it. From February 2020 to March 2022, 103 patients with MIS-C were hospitalized and treated at M.Iashvili Children's Central Hospital, Tbilisi, Georgia. Based on our results, 55% of them had cardiovascular involvement with various manifestations involving coronary artery dilation, valvular insufficiencies, heart rate abnormalities, and pericardial effusion. Our study revealed that only one statistically significant correlation was observed between D-dimer levels and heart rate abnormalities, but there was no correlation between these two values. All of the MIS-C patients reported in our study have received standardized treatment courses with steroids, intravenous immune globulin (IVIG), or IVIG combined with steroids; each patient's illness has resolved without any sequelae, and cardiac manifestations have returned to baseline. Nevertheless, systematic longer-term follow-up is needed to provide clarity on the evolution of medium- and long-term cardiac outcomes in MIS-C.
RESUMEN
Kawasaki disease is a challenging diagnosis even in typical forms of presentation. The features are represented by long lasting fever, specific mucocutaneous signs and coronary artery dilations as expression of medium artery vasculitis of unknown origin. Kawasaki-like disease emerged as a variant of pediatric multisystem inflammatory syndrome (PMIS) associated with COVID-19 infection. A 1 year 9-month-old boy who presented with fever, semi-consistent stools, vomiting, facial edema and hepatomegaly was transferred in our hospital with suspicion of myocarditis due to the clinical presentation, inflammatory markers and systolic dysfunction. In a few days after presentation, also, dilation of the coronary artery appeared while the child had persistent constant symptomatology. Gradually, a pediatric multisystem inflammatory syndrome (PMIS) developed, but without positive markers of COVID-19 infection, which remained negative (both antigen and antibodies). So, in front of all elements of PMIS except exposure to SARS-CoV-2, we concluded for an atypical Kawasaki disease with elements of PMIS. But the debate between the elaborated criteria British and American for PMIS are circling around the demonstration of the infection, past or present, making some cases difficult to diagnose. In this high affluence of Kawasaki-like disease, with intricated elements of myocarditis and multisystem inflammatory syndrome it is more and more difficult to establish a clear diagnosis. While the diagnosis looks complex, the curative treatment goes in the same direction – immunoglobulin, immunosuppressive treatment, inotropic and antiaggregant or anticoagulant treatment. © 2021, MediaMed Publicis. All rights reserved.
RESUMEN
Myocardial dysfunction and coronary artery dilation have been reported in the acute setting of severe acute respiratory syndrome coronavirus disease-2-related multisystem inflammatory syndrome in children. Through a longitudinal echocardiographic single-center study of 15 children, we report the short-term outcomes of cardiac dysfunction and coronary artery dilation in severe acute respiratory syndrome coronavirus disease-2-related multisystem inflammatory syndrome in children.