scholarly journals Post-infectious inflammatory syndrome associated with SARS-CoV-2 in a paediatric patient with Down syndrome

2021 ◽  
Vol 14 (4) ◽  
pp. e240490
Author(s):  
Mellad Khoshnood ◽  
Roshan Mahabir ◽  
Nick M Shillingford ◽  
Jonathan D Santoro
Keyword(s):  
Down Syndrome ◽  
Paediatric Patient ◽  
Cerebrovascular Accident ◽  
Neurological Complications ◽  
Infectious Period ◽  
Unique Case ◽  
Cardiac Lesion ◽  
Immune Mediated ◽  
Inflammatory Syndrome ◽  
Post Infectious

Neurological complications of SARS-CoV-2 continue to be recognised. In children, neurological phenomenon has been reported generally in the acute infectious period. It is possible that SARS-CoV-2 could trigger an immune-mediated post-infectious phenomenon. Here, we present a unique case of post-infectious marantic cardiac lesion causing cerebrovascular accident in a patient with Down syndrome.

Unique presentations of the post COVID-19 infection, multisystem inflammatory syndrome in children.

2021 ◽  
Author(s):  
Amit Nahum ◽  
Keren Rochwerger-Biham
Keyword(s):  
Inflammatory Responses ◽  
Wall Thickening ◽  
Systemic Involvement ◽  
Prolonged Fever ◽  
Immune Mediated ◽  
Mild Reduction ◽  
Myocardial Involvement ◽  
Cardiac Manifestations ◽  
Inflammatory Syndrome ◽  
Post Infectious

Introduction: The epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing COVID-19, continuous to affect most of the world's population. In children, the respiratory and systemic involvement appears to have a much more benign course in comparison to adults, with almost no fatalities reported. However, we are encountering a post-infectious immune mediated condition, termed, multisystem inflammatory syndrome in children (MIS-C). In most cases the main features are prolonged fever and elevation of inflammatory markers, many of the patients present with abdominal pain and varying degree of myocardial involvement from mild reduction in cardiac output to the most alarming manifestation of cardiovascular shock. Results: We present two patients with unusual manifestations of MIS-C, related to post COVID-19 infection, an infant born to a mother who was severely ill at the very end of pregnancy, presenting with prolonged fever, rash, pericardial effusion, and evidence of coronary arteries wall thickening as a result of inflammation, and, a teenage girl with severe cardiac tamponade without the more common cardiac manifestations of myocardial involvement. Discussion: Post COVID-19 MIS-C can present in a wide variety of manifestations. The pathophysiologic mechanism underlying these inflammatory responses in infants are yet to be elucidated. Physicians should be aware of such presentations since rapid diagnosis and treatment are key for favorable outcome.

scholarly journals Neurological manifestations of COVID-19 associated multisystem inflammatory syndrome in adults (MIS-A)

2021 ◽  
Author(s):  
Boby Varkey Maramattom
Keyword(s):  
Critical Illness ◽  
Pulmonary Complication ◽  
Transverse Myelitis ◽  
Neurological Complications ◽  
Neurological Involvement ◽  
Neurological Manifestations ◽  
Acute Encephalopathy ◽  
Extra Pulmonary ◽  
Inflammatory Syndrome ◽  
Post Infectious

Abstract Introduction Multi-system inflammatory syndrome (MIS) is a para infectious or post infectious extra-pulmonary complication of COVID-19. Neurological complications are better described in children with Multi-system inflammatory syndrome (MIS) in children (MIS-C). There is a paucity of literature about the neurological manifestations of Multi-system inflammatory syndrome (MIS) in adults (MIS-A).Materials and methods Over a 12-month period, from June 2020 to June 2021, over 350 patients were admitted to our medical and COVID ICUs. Of these, eight patients (2.2%) admitted to our ICU were detected to have a neurologic MIS-A.Results Most patients had a stroke (72.5%). Other manifestations included transverse myelitis, COVID encephalitis, acute encephalopathy, rhabdomyolysis and critical illness myo-neuropathy.Conclusions Most patients with MIS-A and severe neurological involvement had a poor outcome.

scholarly journals Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 572
Author(s):  
Ravindra Pawar ◽  
Vijay Gavade ◽  
Nivedita Patil ◽  
Vijay Mali ◽  
Amol Girwalkar ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Case Series ◽  
Feeding Intolerance ◽  
Av Block ◽  
Igm Antibodies ◽  
Immune Mediated ◽  
History Of ◽  
Exposure During Pregnancy ◽  
Inflammatory Syndrome ◽  
Post Infectious

Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed.

COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

2021 ◽  
pp. 1-3
Author(s):  
Lesya G. Tomlinson ◽  
Mitchell I. Cohen ◽  
Rebecca E. Levorson ◽  
Megan B. Tzeng
Keyword(s):  
Inflammatory Process ◽  
Myocardial Dysfunction ◽  
Sinus Node ◽  
Qtc Prolongation ◽  
Mild Disease ◽  
Abnormal Immune Response ◽  
Idioventricular Rhythm ◽  
Inflammatory Syndrome ◽  
Electrocardiographic Abnormalities ◽  
Post Infectious

Abstract SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

scholarly journals Cold Agglutinin-Mediated Autoimmune Hemolytic Anemia in Association with Antiphospholipid Syndrome

2021 ◽  
pp. 1-4
Author(s):  
Ram Gelman ◽  
Fadi Kharouf ◽  
Yuval Ishay ◽  
Alexander Gural
Keyword(s):  
Hemolytic Anemia ◽  
Antiphospholipid Syndrome ◽  
Complement Activation ◽  
Autoimmune Hemolytic Anemia ◽  
Cold Agglutinin ◽  
Primary Antiphospholipid Syndrome ◽  
Unique Case ◽  
Hematologic Disorders ◽  
Clear Association ◽  
Immune Mediated

Antiphospholipid syndrome and cold agglutinin-mediated autoimmune hemolytic anemia are 2 distinct immune-mediated hematologic disorders. While no clear association exists between these 2 entities, complement activation is known to occur in both of them. Herein, we report a unique case of cold agglutinin hemolytic anemia in a patient with a known primary antiphospholipid syndrome.

Multisystem Inflammatory Syndrome (MIS-C) in Neonates (MIS-N) Following Maternal SARS CoV-2 COVID-19 Infection

2021 ◽  
Author(s):  
Satyan Lakshminrusimha ◽  
Mark Hudak ◽  
Victoria Dimitriades ◽  
Rosemary Higgins
Keyword(s):  
Current Literature ◽  
Case Reports ◽  
Maternal Infection ◽  
Diagnosis And Management ◽  
Inflammatory Syndrome ◽  
Post Infectious

Children present with multisystem inflammatory syndrome (MIS-C), a post-infectious syndrome presenting a few weeks following an acute SARS CoV-2 infection. A few case reports of neonates presenting with a similar syndrome following maternal infection have been reported. This article summarizes the current literature and outlines the controversies surrounding the diagnosis and management of MIS-C in neonates (MIS-N).

Focal myositis

Neurology ◽  
2018 ◽  
Vol 90 (12) ◽  
pp. e1013-e1020 ◽  
Author(s):  
Laure Gallay ◽  
Arnaud Hot ◽  
Philippe Petiot ◽  
Françoise Thivolet-Bejui ◽  
Delphine Maucort-Boulch ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Cohort Study ◽  
Inflammatory Disease ◽  
Immunosuppressive Drugs ◽  
Serum Creatine Kinase ◽  
Immune Mediated ◽  
Pathologic Features ◽  
Antibody Positivity ◽  
Male Patients ◽  
Inflammatory Syndrome

ObjectiveTo better define in a cohort study the clinical and pathologic features of focal myositis (FM).MethodsWith the use of the usual clinicopathologic definition, each confirmed case of FM in the Lyon University Hospital's myopathologic database between 2000 and 2016 was retrieved. Clinical, pathologic, imaging, serologic, and therapeutic data were collected. When data were missing but feasible, appropriate pathologic analyses were performed.ResultsOf the 924 patients included in the database, 37 (4%) had confirmed FM (14 female, 23 male patients). The main symptoms were pain (n = 30, 81%), muscular mass (n = 16, 43%), erythema at the site of FM (n = 12, 32%), and fever (n = 9, 24%). Serum creatine kinase was normal in most patients (81%); serum immune abnormalities were frequent (inflammatory syndrome in sera [39%], dysglobulinemia [52%], and anti-nuclear antibody positivity [29%]). In addition to confirming previously reported findings, pathologic analyses found significant rates of vasculitis (68%) and fasciitis (73%). Here, FM appeared frequently to be associated with other diseases such as immune-mediated inflammatory disease (IMID; 32%), neoplasia (24%), and radiculopathy (11%). Regarding outcomes, 64% of the cases had received immunosuppressive drugs, and the relapse rate was 41%.ConclusionThe present study suggests that FM is not as innocuous as previously believed, particularly considering the associated disorders. Notably, patients with FM should receive careful IMID and neoplasia screening.

scholarly journals Treatment of recalcitrant orbital inflammatory syndrome with plasmapheresis therapy

2020 ◽  
Vol 13 (1) ◽  
pp. e232379
Author(s):  
Yasaira Rodriguez Torres ◽  
Fereshteh Azad ◽  
Xihui Lin
Keyword(s):  
Case Report ◽  
Significant Role ◽  
Therapeutic Response ◽  
Immunosuppressive Agents ◽  
Significant Proportion ◽  
Idiopathic Orbital Inflammation ◽  
Immune Mediated ◽  
Neurological Conditions ◽  
Inflammatory Syndrome ◽  
Management Challenge

Refractory idiopathic orbital inflammation (IOI) represents a management challenge due to its significant proportion of treatment failures. Currently, there are no established guidelines for recalcitrant IOI and majority of immunosuppressive agents have resulted in variable outcomes. Advancements of plasmapheresis therapy can play a significant role in ophthalmological diseases. This treatment has shown to produce a satisfactory therapeutic response in immune-mediated neurological conditions. In this case report, we share our successful experience with the use of plasmapheresis therapy in a patient with recalcitrant IOI.

scholarly journals Immunological assessment of pediatric multisystem inflammatory syndrome related to COVID-19

2020 ◽  
Author(s):  
Serge Grazioli ◽  
Fedora Tavaglione ◽  
Giulia Torriani ◽  
Noemie Wagner ◽  
Marie Rohr ◽  
...  
Keyword(s):  
T Cell ◽  
T Cell Activation ◽  
Neutralizing Antibodies ◽  
Cell Activation ◽  
Nk Cell ◽  
University Hospitals ◽  
Positive Serology ◽  
Recent Infection ◽  
Inflammatory Syndrome ◽  
Post Infectious

Abstract Background Recently, cases of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 have been reported worldwide. Negative RT-PCR testing associated with positive serology in most cases suggests a post-infectious syndrome. Because the pathophysiology of this syndrome is still poorly understood, extensive virological and immunological investigations are needed. Methods We report a series of four pediatric patients admitted to Geneva University Hospitals with persistent fever and laboratory evidence of inflammation meeting published definition of MIS-C related to COVID-19, to whom an extensive virological and immunological workup was performed. Results RT-PCRs on multiple anatomical compartments were negative whereas anti-SARS-CoV-2 IgA and IgG were strongly positive by ELISA and immunofluorescence. Both pseudo- and full virus neutralization assays showed the presence of neutralizing antibodies in all children, confirming a recent infection with SARS-CoV-2. Analyses of cytokine profiles revealed an elevation in all cytokines, as reported in adults with severe COVID-19. Although differing in clinical presentation, some features of MIS-C show phenotypic overlap with haemophagocytic lymphohistiocytosis (HLH). In contrast to patients with primary HLH, our patients showed normal perforin expression and NK cell degranulation. The levels of soluble IL-2 receptor (sIL-2R) correlated with the severity of disease, reflecting recent T-cell activation. Conclusion Our findings suggest that MIS-C related to COVID-19 is caused by a post-infectious inflammatory syndrome associated with elevation in all cytokines, and markers of recent T-cell activation (sIL-2R) occurring despite a strong and specific humoral response to SARS-CoV2. Further functional and genetic analyses are essential to better understand the mechanisms of host-pathogen interactions.

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