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Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Treated With Infliximab.
Dolinger, Michael T; Person, Hannibal; Smith, Rachel; Jarchin, Lauren; Pittman, Nanci; Dubinsky, Marla C; Lai, Joanne.
  • Dolinger MT; Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY.
J Pediatr Gastroenterol Nutr ; 71(2): 153-155, 2020 08.
Article in English | MEDLINE | ID: covidwho-729245
Semantic information from SemMedBD (by NLM)
1. infliximab TREATS Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
Subject
infliximab
Predicate
TREATS
Object
Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
2. infliximab TREATS Pediatric Disorder
Subject
infliximab
Predicate
TREATS
Object
Pediatric Disorder
3. infliximab TREATS COVID-19
Subject
infliximab
Predicate
TREATS
Object
COVID-19
4. COVID-19 CAUSES Inflammatory Response
Subject
COVID-19
Predicate
CAUSES
Object
Inflammatory Response
5. Crohn Disease PROCESS_OF Patients
Subject
Crohn Disease
Predicate
PROCESS_OF
Object
Patients
6. Face LOCATION_OF Maculopapular Lesion
Subject
Face
Predicate
LOCATION_OF
Object
Maculopapular Lesion
7. Hospitalization TREATS Perianal abscess
Subject
Hospitalization
Predicate
TREATS
Object
Perianal abscess
8. Hospitalization TREATS COVID-19
Subject
Hospitalization
Predicate
TREATS
Object
COVID-19
9. Alpha tumour necrosis factor measurement DIAGNOSES Inflammatory Bowel Diseases
Subject
Alpha tumour necrosis factor measurement
Predicate
DIAGNOSES
Object
Inflammatory Bowel Diseases
10. Alpha tumour necrosis factor measurement DIAGNOSES COVID-19
Subject
Alpha tumour necrosis factor measurement
Predicate
DIAGNOSES
Object
COVID-19
11. Crohn Disease PROCESS_OF Child
Subject
Crohn Disease
Predicate
PROCESS_OF
Object
Child
12. infliximab TREATS Patients
Subject
infliximab
Predicate
TREATS
Object
Patients
13. Anti-Anxiety Agents TREATS Patients
Subject
Anti-Anxiety Agents
Predicate
TREATS
Object
Patients
14. Anti-Anxiety Agents TREATS Child
Subject
Anti-Anxiety Agents
Predicate
TREATS
Object
Child
15. Anti-Anxiety Agents AFFECTS COVID-19
Subject
Anti-Anxiety Agents
Predicate
AFFECTS
Object
COVID-19
16. infliximab TREATS Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
Subject
infliximab
Predicate
TREATS
Object
Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects
17. infliximab TREATS Pediatric Disorder
Subject
infliximab
Predicate
TREATS
Object
Pediatric Disorder
18. infliximab TREATS COVID-19
Subject
infliximab
Predicate
TREATS
Object
COVID-19
19. COVID-19 CAUSES Inflammatory Response
Subject
COVID-19
Predicate
CAUSES
Object
Inflammatory Response
20. Crohn Disease PROCESS_OF Patients
Subject
Crohn Disease
Predicate
PROCESS_OF
Object
Patients
21. Face LOCATION_OF Maculopapular Lesion
Subject
Face
Predicate
LOCATION_OF
Object
Maculopapular Lesion
22. Hospitalization TREATS Perianal abscess
Subject
Hospitalization
Predicate
TREATS
Object
Perianal abscess
23. Hospitalization TREATS COVID-19
Subject
Hospitalization
Predicate
TREATS
Object
COVID-19
24. Alpha tumour necrosis factor measurement DIAGNOSES Inflammatory Bowel Diseases
Subject
Alpha tumour necrosis factor measurement
Predicate
DIAGNOSES
Object
Inflammatory Bowel Diseases
25. Alpha tumour necrosis factor measurement DIAGNOSES COVID-19
Subject
Alpha tumour necrosis factor measurement
Predicate
DIAGNOSES
Object
COVID-19
26. Crohn Disease PROCESS_OF Child
Subject
Crohn Disease
Predicate
PROCESS_OF
Object
Child
27. infliximab TREATS Patients
Subject
infliximab
Predicate
TREATS
Object
Patients
28. Anti-Anxiety Agents TREATS Patients
Subject
Anti-Anxiety Agents
Predicate
TREATS
Object
Patients
29. Anti-Anxiety Agents TREATS Child
Subject
Anti-Anxiety Agents
Predicate
TREATS
Object
Child
30. Anti-Anxiety Agents AFFECTS COVID-19
Subject
Anti-Anxiety Agents
Predicate
AFFECTS
Object
COVID-19
ABSTRACT
Coronavirus disease 2019 (COVID-19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID-19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor-alpha (TNF-α) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS-CoV-2 polymerase chain reaction was positive. Despite inpatient treatment for COVID-19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid-refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)-6, IL-8, and TNF-α, higher than those described in either inflammatory bowel disease or severe COVID-19 alone. The patient was treated with infliximab for TNF-α blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID-19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF-α, a decrease in IL-6, and IL-8 concentrations. This case supports a role for blockade of TNF-α in the treatment of COVID-19 inflammatory cascade. The role of anti-TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID-19 requires further investigation.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Crohn Disease / Ichthyosiform Erythroderma, Congenital / Interleukin-8 / Interleukin-6 / Tumor Necrosis Factor-alpha / Limb Deformities, Congenital / Coronavirus Infections / Genetic Diseases, X-Linked / Infliximab Type of study: Case report Topics: Long Covid Limits: Adolescent / Humans / Male Language: English Journal: J Pediatr Gastroenterol Nutr Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Crohn Disease / Ichthyosiform Erythroderma, Congenital / Interleukin-8 / Interleukin-6 / Tumor Necrosis Factor-alpha / Limb Deformities, Congenital / Coronavirus Infections / Genetic Diseases, X-Linked / Infliximab Type of study: Case report Topics: Long Covid Limits: Adolescent / Humans / Male Language: English Journal: J Pediatr Gastroenterol Nutr Year: 2020 Document Type: Article