Multisystem Inflammatory Syndrome in Children (MIS-C) in an Adolescent that Developed Coronary Aneurysms: A Case Report and Review of the Literature

Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome

“…In those study, most of the patients received IVIG (either a single or multiple infusions), steroids, or both. Conversely, a 15-year-old girl presented with symptoms consistent with PIMS-TS and subsequently developed persistent multiple coronary aneurysms despite one 120-g dose of IVIG, oral aspirin, and steroids ( 4 ). Interestingly, due to acute kidney injury, treatment with IVIG was delayed in our patient, who exhibited persistent aneurysms 2 months after clinical improvement, the latter disappearing only at a later stage.…”

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

“…However, unlike the coronary artery dilations and/or aneurysms observed in MIS-C, which are typically transient and have an onset that coincides with that of fever, the coronary artery aneurysms seen in KD peak ∼3 wk after fever onset ( Jhaveri et al, 2021 ; Matsubara et al, 2020 ; Tsuda and Hashimoto, 2021 ). Importantly, coronary artery abnormalities have been observed not only in the youngest MIS-C patients meeting the full KD criteria, who would be more likely to be considered to have “classic” KD, but also in adolescent patients ( Nelson et al, 2020 ). Physicians should, therefore, consider treating MIS-C patients with low-dose aspirin and intravenous Ig (IVIG) in addition to appropriate cardiovascular resuscitation and steroids, because IVIG (with or without steroids) is the only treatment that has been shown to reduce coronary complications in KD ( Henderson et al, 2020 ; McCrindle et al, 2017 ; Oates-Whitehead et al, 2003 ).…”

“…The pathogenesis of KD remains unclear, but the postinfectious nature of MIS-C, and possibly also of KD, is consistent with an autoinflammatory and/or autoimmune hyperinflammatory process initially triggered by viral infection ( Rowley et al, 1997 ; Rowley et al, 2020 ). The immune response in patients with KD is typically characterized by pro-inflammatory signatures, including increases in IL-1, IL-8, IL-6, and IL-17A levels ( Bajolle et al, 2014 ; Nelson et al, 2020 ; Oates-Whitehead et al, 2003 ), marked leukocytosis, eosinophilia, and high levels of monocytes ( Kanegaye et al, 2009 ; Radia et al, 2020 ), accompanied by high CRP, erythrocyte sedimentation rate, procalcitonin, alanine aminotransferase, and γ-glutamyl transferase levels ( Henderson et al, 2020 ; Radia et al, 2020 ). Many of these features are common to MIS-C (including high levels of cytokines, such as IL-1, IL-8, IL-6, etc.…”

The Challenging Diagnosis of Pediatric Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 Infection-Two Case Reports and Literature Review

“…The mortality rate in pediatric patients is <1% [ 8 , 21 ]. Despite this favorable outcome, in April 2020, a group of clinicians in the UK reported the first cases of hyper inflammation, fever, and cardiovascular shock in 8 previously healthy children [ 2 , 8 ]. Of these patients, all had a significant inflammatory syndrome and negative tests for an acute SARS-CoV-2 infection, although many had recent COVID-19 contact [ 8 ].…”

“…Despite the mild forms of the disease reported within pediatric population, a rare hyperinflammatory syndrome associated with coronavirus infection was described, initially named pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) in Europe and multisystem inflammatory syndrome in children (MIS-C) in the United States [ 4 , 6 , 7 ]. The MIS-C clinical and paraclinical presentation has common characteristics with the presentation of KD, including fever, high levels of inflammatory markers, and multisystem damage (e.g., hematologic, dermatologic, cardiac) [ 8 , 9 ]. Large case series of KD related to SARS-CoV-2 infection from the United Kingdom (UK), Italy, the United States (USA), and France were published last year [ 1 , 4 , 9 , 10 , 11 , 12 ].…”