An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

Abstract

Patient: Female, 11-year-old Final Diagnosis: Pediatrics multisystem inflammatory syndrome Symptoms: Cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: Early in the COVID-19 pandemic, children who were infected with severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) with vascular inflammation were described as having a vasculitis similar to Kawasaki’s disease. There are now consensus clinical guidelines that have described the presentation and diagnosis of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. This report aims to describe a case of MIS-C in an 11-year-old Saudi Arabian girl who presented with coronary artery aneurysm and cardiac involvement. Case Report: We describe an 11-year-old Saudi girl who was asymptomatic for 3 weeks after contracting SARS-CoV-2. Three weeks after suffering a mild flulike illness, she developed a high fever, cough, and severe clinical deterioration within 12 h of admission, including shock, rash, pleural effusion, high inflammatory markers, and a coronary aneurysm. As per current practice, the diagnosis was confirmed as multisystem inflammatory syndrome based on a SARS-CoV-2 test with reverse transcription polymerase chain reaction (RT-PCR) from 2 nasopharyngeal aspirates. Her condition was successfully treated with antibiotics, inotropes, IVIG, aspirin, and Tocilizumab, in addition to high-flow oxygen therapy. Eventually, she was able to return home after fully recovering. Conclusions: The findings in this report suggest that children with MIS-C due to SARS-CoV-2 infection can have a good prognosis, even when they suffer from coronary artery and cardiac involvement. The increasing number of emerging SARS-CoV-2 variants that affect children supports the importance of RT-PCR for the COVID-19 diagnostic test for children with multisystem or cardiovascular inflammation, which may guide the most appropriate clinical management of the variants of MIS-C.

Rationale for use for monoclonal antibody therapy in multisystem inflammatory syndrome in children: a systematic review

“…Monoclonal antibodies are relatively novel and expensive drugs with limited availability. Some institutions can face di culties in acquiring certain monoclonal antibodies 12,30 . As a suspected post-infectious in ammatory syndrome after COVID-19, most patients are negative for RT-PCR but positive for serology 6,35 .…”

“…Monoclonal antibodies were used less frequently. Most patients responded well to monoclonal antibodies, although a single case by Al Qahtani et al with little response to biologic agent occurred until IVIG was prescribed 12 . Currently, there is a scarcity of data on the long-term effects of MIS-C over several months to years and we had a similar issue in reviewing these papers.…”

“…In two studies, initial biologics utilized were changed to a second monoclonal antibody 14,31 . Only two studies followed up on their patients to screen for possible long-term implications of disease and treatment 12,28 .…”

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…Gastrointestinal symptoms were also described but to a lesser extent ( Almoosa et al, 2020 ; Alharbi et al, 2021 ; Almuzaini et al, 2021 ; Alnajjar et al, 2021 ; Shahin et al, 2021 ). In some patients, the infection was first asymptomatic and presented later as a complicated course in the form of MIC-S ( Almoosa et al, 2020 ; Al Qahtani et al, 2021 Shahin et al, 2021 ; Table 2 ). Among symptomatic ones, the rate of hospitalization ranged from 4.4% ( Hijazi et al, 2021 ) to 9.6% ( Alharbi et al, 2021 ).…”

A Ruptured Left Gastric Artery Aneurysm That Neoplasticized during the Course of Coronavirus Disease 2019: A Case Report

“…Among the extrapulmonary complications, vascular disorders have been reported to induce the formation, enlargement, and rupture of aortic aneurysms, as well as the enlargement and rupture of existing aneurysms in medium-sized vessels, such as the cerebral arteries [ 6 , 7 , 8 ]. Additionally, they can present themselves with findings and symptoms similar to those of Kawasaki disease, including the formation of coronary artery aneurysms [ 9 , 10 ]. While there are reports of aneurysm formation in medium-sized vessels, such as the cerebral and coronary arteries, to the best of our knowledge, no studies to date have reported aneurysm formation in medium-sized vessels other than the cerebral and coronary arteries, such as the celiac arteries and arteries beyond the superior and inferior mesenteric arteries.…”