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Background. Due to the rarity of the combination of emergence diabetes mellitus type 1 (DM1), COVID-19, and multisystem inflammatory syndrome, each reported case represents valuable experience and increases the awareness of medical professionals. Clinical case description. A 7-year-old boy was admitted to the intensive care unit with a diagnosis of diabetes mellitus type 1, first identified. On day 2, ketoacidotic coma with a hyperosmolar component developed, a positive polymerase chain reaction (PCR) test for SARS-CoV-2 was obtained, and a picture of subarachnoid hemorrhage was described according to CT scans of the brain. On day 3, macrohematuria, peripheral edema, pasty complexion were noted; the clinical picture and laboratory examination data corresponded to a “cytokine storm” with the development of multiple organ failure. On day 5, tonic-clonic seizures and bloody discharge from the nasopharynx were noted. On day 6, a negative PCR test for SARS-CoV-2 was obtained, on chest X-rays there was a heterogeneous decrease in pneumatization in the basal sections on both sides, and bilateral hydrothorax. On day 9, meningeal symptoms were noted. On day 14, a repeated episode of a convulsive attack was registered, and changes in the brain according to MRI results were regarded as an inflammatory demyelinating lesion against the background of the course of multisystem inflammatory syndrome and DM or as posterior reversible encephalopathy (PRES syndrome). Against the background of the appointment of immunomodulatory, anticoagulant, antibacterial, antiviral therapy, positive dynamics was noted in the child's condition. On day 18, the patient in a stable condition of moderate severity was transferred to the Department of Pediatric Endocrinology for further treatment. After 14 days, the child was discharged from the hospital in a satisfactory condition. Conclusion. This case report may confirm the risk of developing multisystem inflammatory syndrome in children with DM1 and COVID-19, which requires an interdisciplinary approach and the appointment of therapy included in the standards of management of children with multisystem inflammatory syndrome.
Background. Due to the rarity of the combination of emergence diabetes mellitus type 1 (DM1), COVID-19, and multisystem inflammatory syndrome, each reported case represents valuable experience and increases the awareness of medical professionals. Clinical case description. A 7-year-old boy was admitted to the intensive care unit with a diagnosis of diabetes mellitus type 1, first identified. On day 2, ketoacidotic coma with a hyperosmolar component developed, a positive polymerase chain reaction (PCR) test for SARS-CoV-2 was obtained, and a picture of subarachnoid hemorrhage was described according to CT scans of the brain. On day 3, macrohematuria, peripheral edema, pasty complexion were noted; the clinical picture and laboratory examination data corresponded to a “cytokine storm” with the development of multiple organ failure. On day 5, tonic-clonic seizures and bloody discharge from the nasopharynx were noted. On day 6, a negative PCR test for SARS-CoV-2 was obtained, on chest X-rays there was a heterogeneous decrease in pneumatization in the basal sections on both sides, and bilateral hydrothorax. On day 9, meningeal symptoms were noted. On day 14, a repeated episode of a convulsive attack was registered, and changes in the brain according to MRI results were regarded as an inflammatory demyelinating lesion against the background of the course of multisystem inflammatory syndrome and DM or as posterior reversible encephalopathy (PRES syndrome). Against the background of the appointment of immunomodulatory, anticoagulant, antibacterial, antiviral therapy, positive dynamics was noted in the child's condition. On day 18, the patient in a stable condition of moderate severity was transferred to the Department of Pediatric Endocrinology for further treatment. After 14 days, the child was discharged from the hospital in a satisfactory condition. Conclusion. This case report may confirm the risk of developing multisystem inflammatory syndrome in children with DM1 and COVID-19, which requires an interdisciplinary approach and the appointment of therapy included in the standards of management of children with multisystem inflammatory syndrome.
Background. In the context of coronavirus diseases 2019 (COVID-19) pandemic associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a significant number of cases resembling Kawasaki disease in children have been reported worldwide and eventually termed “multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2”. Objective: to compare the clinical presentation, laboratory findings, and instrumental examination data in children with Kawasaki-like MIS-C phenotype and MIS-C with a shock phenotype with cases, which met the US Centers for Disease Control and Prevention criteria. Materials and methods. The article presents the results of a retrospective analysis of the disease histories in 20 children aged 2.5 to 16 years with a Kawasaki-like MIS-C phenotype and with MIS-C with a shock phenotype associated with SARS-CoV-2 infection who were hospitalized in the MNPE “Kyiv City Children’s Clinical Hospital 2” in 2002–2021. Results. Patients were divided into 2 groups according to symptoms and pathological conditions. Group I included children with clinical signs similar to the Kawasaki disease (n = 8). They were classified as those with Kawasaki-like MIS-C phenotype. Complications such as coronary artery dilatations and aneurysms occurred only in this group. Group II consisted of patients (n = 12) who were classified as those with MIS-C with a shock phenotype. Children in this group had a higher number of involved organ systems, were more likely to have shock, pleuritis, peritonitis, and a higher prevalence of abdominal pain. Furthermore, they exhibited elevated levels of leukocytes and neutrophils (p = 0.043; p = 0.047), along with a higher neutrophil-to-lymphocyte ratio (p = 0.05), compared to the patients with Kawasaki-like phenotype. Conclusions. Our results suggest that multisystem inflammatory syndrome associated with SARS-CoV-2 in children is characterized by a wide range of clinical, laboratory and instrumental signs. Moreover, our findings highlight that children with features that correspond to MIS-C with a shock phenotype tend to have a more severe course of the disease and a higher rate of complications.
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