New-onset diabetic ketoacidosis with purpura fulminans in a child with COVID-19-related multisystem inflammatory syndrome.
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.Keywords
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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