The Rule of Low Molecular Weight Heparin in Children with Misc Case Series in Tertiary Hospital in Indonesia

ABSTRACT

BACKGROUND AND AIM: The number of children and adults infected with SARS-CoV-2 are disproportionate, due to relatively different clinical manifestations and lack of SARS-CoV-2 detection in children. Recently, there was an emergence of clustered cases of children infected with SARS-CoV-2 presenting with severe clinical manifestation that comprised gastrointestinal symptoms, features of myocarditis, hemodynamic instability, coagulopathy and mucocutaneous inflammation reaction. This entire severe spectrum of SARS-CoV-2 infection is referred to as Multisystem Inflammatory Syndrome in Children (MIS-C). This study aims to review 3 cases of MIS-C in our centre, Sanglah Hospital. METHOD(S) This study reported 3 cases of MIS-C in patients aged 1-8 years old. Out of 3 cases, 2 cases were complicated with other underlying disease, case 1 was complicated with pleural tuberculosis while case 3 was complicated with malnutrition, down syndrome and global developmental delay (GDD). RESULT(S) All patients presented with high fever ranging from 38,6oC to 40oC, multi-organ involvement, evidence of increased inflammatory markers (ESR, CRP, procalcitonin) and increased D-dimer. All patients were treated with low molecular weight heparin using enoxaparin, multivitamin and other symptomatic treatments according to their clinical manifestations and underlying condition. CONCLUSION(S) Number of MIS-C cases has been increasing from over the world suggesting that this hyperinflammatory disease should be widely recognized and necessitate prompt treatment. MIS-C is a potentially serious and life-threatening illness, with reported mortality rate of approximately 2%. Main treatment of MIS-C comprised of immunomodulators, antiplatelet, anticoagulant, systemic glucocorticoids and other supporting therapy.