1387: Encephalopathy and Life-Threatening Gastrointestinal Hemorrhage in a Child With Mis-C

Burton, William; Rutledge, Chrystal; Loberger, Jeremy; Rockwell, Nicholas; Cooper, Joshua; Lawrence, Maggie; Sasser, William C

doi:10.1097/01.ccm.0000811872.42138.97

Cited by 2 publications

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“…The abstract for this case was submitted and accepted for a Research Snapshot Presentation for the Society of Critical Care Medicine's 2022 Critical Care Congress. Critical Care Medicine , one of the Society of Critical Care Medicine's journals, published the abstract in a supplemental volume containing Critical Care Congress abstracts [ 18 ].…”

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confidence: 99%

Unique Complications of MIS-C and Its Treatment: Encephalopathy in a Child with MIS-C Who Developed Life-Threatening Gastrointestinal Hemorrhage

Burton

Manchikalapati

Rutledge

et al. 2022

Case Reports in Critical Care

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In this case report, we describe a previously healthy eleven-year-old male diagnosed with multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019. The patient presented with shock and neurologic symptoms including altered mental status and dysarthria. Brain magnetic resonance imaging, obtained to rule out thromboembolic injury, demonstrated cytotoxic edema of the corpus callosum, an imaging finding similar in nature to several previous reports of MRI abnormalities in children with MIS-C. Following administration of intravenous immunoglobulin and pulse-dose steroids, the patient convalesced and was discharged home. Medications prescribed upon discharge included a steroid taper, daily aspirin, and proton pump inhibitor. Four days later, he was readmitted with shock and life-threatening gastrointestinal (GI) hemorrhage. After extensive evaluation of potential bleeding sources, angiography revealed active bleeding from two arterial vessels supplying the duodenum. The patient demonstrated no further signs of bleeding following successful coil embolization of the two vessels. We hypothesize that the vasculitic nature of MIS-C combined with anti-inflammatory and antithrombotic therapy placed him at risk of GI hemorrhage. This case highlights unique radiologic features of MIS-C as well as potential complications of treatment.

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Section: Disclosurementioning

confidence: 99%

Unique Complications of MIS-C and Its Treatment: Encephalopathy in a Child with MIS-C Who Developed Life-Threatening Gastrointestinal Hemorrhage

Burton

Manchikalapati

Rutledge

et al. 2022

Case Reports in Critical Care

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Aspirin/steroids

2022

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An 11-year-old boy developed gastrointestinal haemorrhage following treatment with aspirin and unspecified steroids for multisystem inflammatory syndrome in children (MIS-C) [dosages and routes not stated].The boy was admitted to paediatric ICU. Considering clinical appearance, laboratory evaluation and SARS-CoV-2 antibody profile, he was diagnosed with MIS-C. He presented with mild shock, dysarthria and encephalopathy. Brain MRI revealed cytotoxic oedema of the corpus callosum. He received IV immune globulin [immunoglobulin] and pulse dose of unspecified steroids. Subsequently, he convalesced and was discharged home. His discharge medications included aspirin, unspecified tapered steroids and unspecified proton pump inhibitors. After four days, he presented with shock and life-threatening gastrointestinal haemorrhage.The boy was treated with large scale resuscitation with unspecified vasoactive agents and twice his own circulatory volume delivered by a rapid infusion system. An angiography along with extensive evaluation revealed bleeding from two arterial vessels supplying the duodenum. He underwent successful coil embolization of two arteries and did not demonstrate any further bleeding.

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1387: Encephalopathy and Life-Threatening Gastrointestinal Hemorrhage in a Child With Mis-C

Cited by 2 publications

References 0 publications

Unique Complications of MIS-C and Its Treatment: Encephalopathy in a Child with MIS-C Who Developed Life-Threatening Gastrointestinal Hemorrhage

Unique Complications of MIS-C and Its Treatment: Encephalopathy in a Child with MIS-C Who Developed Life-Threatening Gastrointestinal Hemorrhage

Aspirin/steroids

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