Multisystem Inflammatory Syndrome in a Child Associated With Coronavirus Disease 19 in the Brazilian Amazon: Fatal Outcome in an Infant

Abstract

Objective: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case description: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. Comments: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… [ 228 ] 5 (all confirmed) N.A. 84.4m PMIS-TS None Recovered [ 229 ] 1 (confirmed) F 7m MIS-C Glucocorticoids Death [ 230 ] 2 (1 confirmed) 2 M 31m PIMS-TS None 1 Death [ 231 ] 1 (confirmed) N.A. N.A.…”

SARS-CoV-2–related MIS-C: A key to the viral and genetic causes of Kawasaki disease?

“…Patients with MIS-C were initially described as having conjunctivitis, cheilitis, rash, and shock ( de Farias et al, 2020 ; Farias et al, 2020 ; Jones et al, 2020 ; Riphagen et al, 2020 ; Toubiana et al, 2020b ; Verdoni et al, 2020 ; Whittaker et al, 2020 ), immediately inciting comparisons with KD, which has been described as a multisystem inflammatory vasculitis presenting with fever, acute mucocutaneous inflammation, and KD shock syndrome ( McCrindle et al, 2017 ; Riphagen et al, 2020 ). Indeed, all MIS-C patients present with fever, and about half have a rash and bilateral bulbar conjunctival injection, as observed in KD.…”

“…However, in the spring of 2020, clusters of children admitted to the hospital with a multisystem hyperinflammatory syndrome, presenting with fever, abdominal pain and/or rash, myocarditis, and other clinical features reminiscent of Kawasaki disease (KD), were reported in communities with high rates of COVID-19, across Europe, and in North and South America ( Fig. 1 and Table 1 ; de Farias et al, 2020 ; Farias et al, 2020 ; Jones et al, 2020 ; Riphagen et al, 2020 ; Toubiana et al, 2020b ; Verdoni et al, 2020 ; Whittaker et al, 2020 ). Initial reports described a condition they referred to as an atypical form of KD with an incidence 30 times higher than in previous years ( Verdoni et al, 2020 ).…”

Perinatal SARS-CoV-2 Infection and Neonatal COVID-19: A 2021 Update

“…Of note, a fatal case of MIS-C in the NICU was reported in a 7-month-old infant born at 26 weeks' gestation who was hospitalized since birth and acquired acute SARS-CoV-2 infection from an unknown source. (68) The infant subsequently developed cardiovascular collapse with elevated inflammatory markers and echocardiographic evidence of myocarditis. (68) Recently a 4-hour-old term infant born to a mother without history of COVID-19 has been reported to have developed persistent pulmonary hypertension of the newborn (PPHN) and subsequently had multisystem involvement (fever, bilateral ground glass opacities, necrotizing enterocolitis-like illness, vasculitic rash, and elevated inflammatory markers and D-dimer).…”