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New-onset diabetic ketoacidosis with purpura fulminans in a child with COVID-19-related multisystem inflammatory syndrome.
Parappil, Parvathi; Ghimire, Sushant; Saxena, Apoorv; Mukherjee, Sweta; John, B M; Sondhi, Vishal; Sengupta, P; Acharya, Suchi.
  • Parappil P; Department of Pediatrics, AFMC, Pune, India.
  • Ghimire S; Department of Pediatrics, AFMC, Pune, India.
  • Saxena A; Department of Pediatrics, AFMC, Pune, India.
  • Mukherjee S; Department of Pediatrics, Command Hospital (SC), Pune, India.
  • John BM; Department of Pediatrics, AFMC, Pune, India.
  • Sondhi V; Department of Pediatrics, AFMC, Pune, India.
  • Sengupta P; Department of Pathology, Command Hospital, Kolkota, India.
  • Acharya S; Department of Pediatrics, AFMC, Pune, India.
Infect Dis (Lond) ; 54(7): 522-528, 2022 07.
Article in English | MEDLINE | ID: covidwho-1752046
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID 19) usually causes a mild illness among children. However, in a minority of children, it may be associated with the life-threatening multisystem inflammatory syndrome (MIS-C), or thrombotic microangiopathy, or sequelae like type-1 diabetes mellitus (T1DM). We describe a previously healthy, 12-year-old boy with new-onset T1DM with diabetic ketoacidosis (DKA) in the setting of MIS-C, with a course complicated by thrombotic microangiopathy. CASE PRESENTATION The patient presented with four days history of fever, non-bilious vomiting, polyuria and polydipsia. On evaluation, he was noted to have diabetic ketoacidosis. Although Diabetic ketoacidosis with insulin and intravenous fluids, his hospital course was notable for shock requiring vasopressor, purpura fulminans with eschar formation, neurological manifestations (left hemiparesis due to right middle cerebral artery territory infarct, mononeuritis multiplex) and thrombotic microangiopathy. MIS-C-like illness secondary to COVID-19 was suspected due to diabetic ketoacidosis, thrombotic microangiopathy, elevated inflammatory markers, history of contact with COVID-19-infected individual and detectable COVID-19 IgG antibodies. He improved following management with methylprednisolone, intravenous immunoglobulin, low-molecular-weight heparin and aspirin, and was discharged on hospital day 48.

CONCLUSION:

MIS-C-like illness should be considered in children and adolescents presenting with complex multisystem involvement in this era of COVID 19. Management with immunomodulatory agents can be lifesaving.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetic Ketoacidosis / Diabetes Mellitus, Type 1 / Purpura Fulminans / Thrombotic Microangiopathies / COVID-19 Type of study: Case report / Experimental Studies / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Humans / Male Language: English Journal: Infect Dis (Lond) Year: 2022 Document Type: Article Affiliation country: 23744235.2022.2050423

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetic Ketoacidosis / Diabetes Mellitus, Type 1 / Purpura Fulminans / Thrombotic Microangiopathies / COVID-19 Type of study: Case report / Experimental Studies / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Humans / Male Language: English Journal: Infect Dis (Lond) Year: 2022 Document Type: Article Affiliation country: 23744235.2022.2050423