Electrical storm in a child with post-acute coronavirus infection Acinetobacter endocarditis

ABSTRACT

Background: Electrical storm (ES) characterised by multiple episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) represents an increasingly difficult management problem in critical care. (1) Although, it occurs more frequently in adults, there are reports of its occurrence in children. Common causes of ES include genetic, structural heart disease and few reversible causes like endocarditis, myocarditis. In post corona virus (COVID) era, multisystem inflammatory syndrome in children (MISC) represents common cause of myocarditis in children. MISC can also be associated with superadded bacterial infection, of which endocarditis represent life threatening entity. Acinetobacter endocarditis is a rare causative agent of endocarditis in children. (2) We present an interesting case of ES in MISC state with endocarditis. Case report A 2 month old child presented to the emergency department (ED) with hemodynamically significant ventricular tachycardia (VT) which was reverted with electrical cardioversion. Amiodarone and propranolol therapy was initiated, despite which the child suffered four episodes of hemodynamically significant VT in next 24 hours requiring electrical cardioversion and was put on elective invasive ventilation. Echocardiography revealed intracardiac hyperechoic oscillating mass attached to anterior mitral leaflet with normal left ventricular systolic function. (Fig 48) Blood investigations revealed raised anti COVID antibody with high inflammatory markers. Blood culture drawn at admission was positive for Acinetobacter and was treated with appropriate antibiotics. The child had VT free period of four days with pulse methylprednisolone and amiodarone. The child was gradually weaned from ventilator and put on non-invasive ventilation (NIV). While on NIV the child suffered another cardiac arrest, cause of which could not be ascertained. During this episode, the child suffered from irreversible neurological damage and eventually succumbed in the next 24 hours. Conclusion(s) MISC myocarditis and endocarditis both represent a state of high mortality, compounded more by electrical storm which can be difficult to manage, as in our case. [Formula presented] Copyright © 2022