Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Treated With Infliximab.
J Pediatr Gastroenterol Nutr
; 71(2): 153-155, 2020 08.
Artículo
en Inglés
| MEDLINE | ID: covidwho-729245
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.
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Neumonía Viral
/
Enfermedad de Crohn
/
Eritrodermia Ictiosiforme Congénita
/
Interleucina-8
/
Interleucina-6
/
Factor de Necrosis Tumoral alfa
/
Deformidades Congénitas de las Extremidades
/
Infecciones por Coronavirus
/
Enfermedades Genéticas Ligadas al Cromosoma X
/
Infliximab
Tipo de estudio:
Reporte de caso
Tópicos:
Covid persistente
Límite:
Adolescente
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
J Pediatr Gastroenterol Nutr
Año:
2020
Tipo del documento:
Artículo
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