scholarly journals Multisystem inflammatory syndrome in Indian adolescents associated with SARS-CoV-2 infection: a case report

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Rahul D. Bhiwgade ◽  
M. C. Nischitha ◽  
Bhushan Shahare ◽  
Shobhna Bitey
Keyword(s):  
Kawasaki Disease ◽  
Severe Disease ◽  
Late Presentation ◽  
Case Presentation ◽  
Empiric Antibiotics ◽  
Non Invasive ◽  
Indian Adolescents ◽  
Atypical Kawasaki Disease ◽  
Polymerase Chain ◽  
Inflammatory Syndrome

Abstract Background Adolescents with coronavirus disease 2019 (COVID-19) associated multisystem inflammatory syndrome (MIS) can present with shock and myocardial injury and mimic Kawasaki disease. Case presentation We describe 4 previously well adolescents (age 13–14 years), presenting with clinical features of MIS in children (MIS-C). All patients had nearly similar clinical presentation. Hematological investigations revealed elevated inflammatory markers, anemia, thrombocytopenia, and decreased neutrophil:lymphocyte ratio. All patients were negative on real-time polymerase chain reaction against severe acute respiratory syndrome coronavirus 2, but had elevated immunoglobulin G titers. Two patients had atypical Kawasaki disease. Three patients had severe disease with hypotensive shock and required intensive care with fluids and inotropes. Two patients required non-invasive respiratory support for dyspnea and one patient had biventricular dysfunction. All received empiric antibiotics, low-molecular weight heparin, steroids, and intravenous immunoglobulin. One patient succumbed, while others recovered well. Conclusions MIS-C may be a late presentation in adolescent with COVID-19. Individualized treatment with empiric antibiotics, immunomodulation, and thromboprophylaxis can result in significantly better outcome.

scholarly journals Unusual Presentation of Kawasaki Disease with Multisystem Inflammation and Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2: A Case Report

2020 ◽  
Author(s):  
Haena Kim ◽  
Jung Yeon Shim ◽  
Jae-Hoon Ko ◽  
Aram Yang ◽  
Jae Won Shim ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Severe Acute Respiratory Syndrome ◽  
Signs And Symptoms ◽  
Enzyme Linked Immunosorbent Assay ◽  
Igg Antibodies ◽  
Case Presentation ◽  
History Of ◽  
Polymerase Chain ◽  
High Index Of Suspicion ◽  
Inflammatory Syndrome

Abstract Background: Since mid-April 2020, cases of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) that mimic Kawasaki disease (KD) have been reported in Europe and North America. However, no cases have been in East Asia, where KD is more prevalent.Case presentation: A previously healthy 11-year-old boy was admitted with a 4-day history of fever and abdominal pain. He had no contact history to any patient with COVID-19. Blood acute inflammatory markers were highly elevated. He was treated with antibiotics for suspected bacterial enteritis, but he suddenly developed hypotension. Inotropics and intravenous immunoglobulin were administered to manage septic shock. On hospitalization day 6, he developed signs and symptoms of KD (conjunctival injection, strawberry tongue, cracked lip, and coronary artery dilatation) in addition to pleural/pericardial effusion and mesenteric lymphadenitis. The results of microbiologic tests, including reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were negative. Fluorescent immunoassay and enzyme-linked immunosorbent assay revealed abundant IgG antibodies against SARS-CoV-2 in his serum, but no IgM antibodies. He was discharged successfully on day 13.Conclusion: MIS-C may occur in children with a previously asymptomatic COVID-19 infection. A high index of suspicion is required for this novel syndrome in unusual cases of KD or KD shock syndrome with multisystem inflammation, even when there is no clear history of contact or symptoms of COVID-19.

scholarly journals Trends in oxygen therapy in patients with moderate to severe COVID-19 admitted to the ICU

2021 ◽  
Vol 8 (4) ◽  
pp. 10-14
Author(s):  
Raghunath S S ◽  
Bheema Devanand ◽  
Mohammed Nizamuddeen B ◽  
Bala Bhaskar S ◽  
Pradnya Kothari ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Comfort Level ◽  
Chi Square ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Chi Square Test ◽  
Polymerase Chain ◽  
Ethical Clearance

The most concerning complication of severe acute respiratory syndrome corona virus 2 (SARSCoV-2) pneumonia is acute hypoxemic failure. Though various antivirals, steroids, immunomodulators have been tried, oxygen therapy remains the mainstay of treatment. After obtaining institutional ethical clearance, a prospective observational study was conducted on 102 COVID-19 positive patients aged 20 years and above, admitted in the ICU with moderate to severe disease. COVID-19 infection was confirmed by polymerase chain reaction or rapid antigen test. Data of two demographically comparable groups i.e., patients on HFNO and NIV was analysed outcome was defined as discharge from ICU, shift to other non-invasive modes of oxygen therapy, endotracheal intubation or death, and comfort level for each mode. The data was analysed using SPSS-16.0, Chi-square test and “t” value test were applied.Comparison ofthe mean number of invasive ventilator free days of HFNO and NIV was insignificant(p>0.05). Among the patients on HFNO (high flow nasal oxygen) 49.09% were stepped down to NRB (non-rebreathing mask) whereas 7.27% went for intubation which is significant compared to NIV mask (non-invasive ventilation), where 13.64% were stepped down to HFNO and 34.09% were intubated (p=0.000).Oxygen therapy with HFNO is associated with better outcome and less mortality when compared with NIV.

Extensive coronary and systemic arterial aneurysm development in severe refractory Kawasaki disease

2016 ◽  
Vol 27 (2) ◽  
pp. 375-376 ◽  
Author(s):  
Niall Johnston ◽  
David Coleman ◽  
Colin J. McMahon
Keyword(s):  
Kawasaki Disease ◽  
Coronary Thrombosis ◽  
Systemic Circulation ◽  
Late Presentation ◽  
Arterial Aneurysm ◽  
Atypical Kawasaki Disease ◽  
Aneurysm Development ◽  
Arterial Aneurysms

AbstractWe describe the case of an 8-week-old infant with late presentation of severe refractory atypical Kawasaki disease. In addition to developing giant coronary arterial aneurysms and coronary thrombosis, she formed extensive bilateral arterial aneurysms throughout her systemic circulation.

scholarly journals Affinché non MIS-Cappi il caso: la sindrome infiammatoria multisistemica SARS-CoV-2-correlata

2021 ◽  
Vol 24 (10) ◽  
pp. 289-297
Author(s):  
Salvatore Giordano ◽  
Ilaria Pirrone ◽  
Giulia Angela Restivo ◽  
Filippo Collura ◽  
Giovanni Francesco Saia ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Rare Condition ◽  
Good Prognosis ◽  
Left Ventricular ◽  
Case Definition ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reactive Protein ◽  
Atypical Kawasaki Disease ◽  
Inflammatory Syndrome

Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes incidence as well as clinical, laboratoristic and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

scholarly journals Case report: Pediatric patients with COVID-19 presented as multi-system inflammatory syndrome

2020 ◽  
Author(s):  
Amir Saeed ◽  
anahita sanaei ◽  
shabnam Hajiani Ghotbabadi ◽  
Eslam shorafa
Keyword(s):  
Case Report ◽  
Kawasaki Disease ◽  
World Health Organization ◽  
Pediatric Patients ◽  
World Health ◽  
Atypical Presentation ◽  
Case Presentation ◽  
Myocardial Involvement ◽  
Health Organization ◽  
Inflammatory Syndrome

Abstract Background COVID-19 in pediatric patients is typically associated with minimal manifestations and is less severe than adult patients. Recently, there are reports of children with COVID 19 and myocardial involvement from Europe and America that first were assumed to be Kawasaki disease or its atypical presentation. However world health organization has set a new designation for this state; “multi-system involvement syndrome” in children with COVID-19; (MIS-C). Case presentation: Here we report two COVID-19 pediatric patients (two girls aged 10 and 13 years old) with MIS-C. Conclusion Presence of Kawasaki like signs in COVID 19 patients should be an alarming point to consider multi-system inflammatory syndrome; a syndrome with extensive organ involvement and yet indistinct exact pathophysiology.

scholarly journals Case Report: Changes in Cytokine Kinetics During the Course of Disease in a Japanese Patient With Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Satoshi Takasago ◽  
Aiko Sakai ◽  
Masaya Sugiyama ◽  
Masashi Mizokami ◽  
Hiromichi Hamada ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Acute Myocarditis ◽  
Severe Disease ◽  
Gastrointestinal Symptoms ◽  
Disease Status ◽  
Classical Trajectory ◽  
Course Of Disease ◽  
Old Japanese ◽  
Cervical Swelling ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in children (MIS-C) is a severe disease that is reportedly linked to coronavirus disease 2019. Affected patients present with gastrointestinal symptoms and cardiovascular dysfunction, in addition to Kawasaki disease-like features, suggesting the potential for overlapping disease mechanisms. Kawasaki disease has been reported among individuals of East Asian ethnicities, whereas there is minimal clinical literature regarding the occurrence of MIS-C among individuals of Asian ethnicities. A few reports thus far have described changes in cytokine kinetics during the course of disease in patients with MIS-C. We followed the temporal cytokine kinetics in a 9-year-old Japanese girl who exhibited a classical trajectory of MIS-C. The patient exhibited right cervical swelling and pain, abdominal pain, vomiting, and lip reddening, which developed 31 days after she was diagnosed with severe acute respiratory syndrome coronavirus-2 infection. The patient was diagnosed with Kawasaki disease on her fifth day of illness; because she fulfilled the criteria for MIS-C, she was also diagnosed with this disease on her fifth day of illness. Her fever rapidly resolved upon administration of intravenous immunoglobulin, aspirin, and prednisolone. On the patient's sixth day of illness, she developed acute myocarditis, which was treated with two diuretics and one vasodilator; the myocarditis ameliorated within a few days. Analyses of temporal kinetics for 71 serum cytokines revealed several patterns of cytokine changes that were consistent with the patient's clinical course of disease. Importantly, there was a clear distinction between cytokines that did and did not decrease rapidly following post-treatment fever resolution. These findings may be useful for the assessment of disease status and selection of therapy in patients with similar symptoms; they may also provide insights for basic and clinical research regarding MIS-C.

scholarly journals Multisystem Inflammatory Syndrome with Features of Atypical Kawasaki Disease during COVID-19 Pandemic

2020 ◽  
Vol 87 (9) ◽  
pp. 745-747 ◽  
Author(s):  
Abdul Rauf ◽  
Ajay Vijayan ◽  
Shaji Thomas John ◽  
Raghuram Krishnan ◽  
Abdul Latheef
Keyword(s):  
Kawasaki Disease ◽  
Atypical Kawasaki Disease ◽  
Inflammatory Syndrome

scholarly journals Multisystem inflammatory syndrome with features of Atypical Kawasaki disease during COVID-19 pandemic: Report of a case from India

2020 ◽  
Author(s):  
Abdul Rauf ◽  
Ajay Vijayan ◽  
Shaji Thomas John ◽  
Raghuram A Krishnan ◽  
Abdul Latheef
Keyword(s):  
Kawasaki Disease ◽  
Elevated Serum ◽  
Febrile Illness ◽  
Left Ventricular ◽  
Number Of Children ◽  
Inflammatory Parameters ◽  
Lv Dysfunction ◽  
Atypical Kawasaki Disease ◽  
Kerala State ◽  
Inflammatory Syndrome

Abstract There is a global concern of increasing number of children presenting with inflammatory syndrome with clinical features simulating Kawasaki disease, during ongoing COVID-19 pandemic. We report a very similar case of 5-year-old boy from a COVID-19 hotspot area in Kerala state of India who presented in late April 2020 with acute febrile illness with abdominal pain and loose stools followed by shock. On examination, child had bulbar conjunctivitis and extremity edema. Initial investigations showed high inflammatory parameters, elevated serum creatinine and liver enzymes. Echocardiography showed moderate LV dysfunction and normal coronaries. Cardiac enzymes were also elevated, suggesting myocarditis. He was treated with inotropic support, respiratory support with High Flow Nasal Cannula, IV Immunoglobulins, aspirin, steroids and diuretics. RT PCR for SARS-CoV-2 was negative twice. His clinical condition improved rapidly, was afebrile from day 2, inflammatory parameters decreased, left ventricular function improved and was discharged after 6 days of hospital stay.

scholarly journals Cardiac Dysfunction in a Child with Severe Multisystem Inflammatory Syndrome

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Gabriela Marengone Altizani ◽  
Karin Barszcz ◽  
Laura Cardoso Brentini ◽  
Karina Amelia Morikawa ◽  
Kelly Luisa Cintra ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Early Diagnosis ◽  
Cardiogenic Shock ◽  
Prospective Studies ◽  
Cardiac Dysfunction ◽  
Respiratory Symptoms ◽  
Acute Myocarditis ◽  
Case Presentation ◽  
Inflammatory Syndrome

Introduction: Albeit most children infected with SARS-CoV-2 are asymptomatic or have mild respiratory symptoms, similar cases of Kawasaki disease and ç increased at the end of April 2020 worldwide. Systemic inflammatory involvement characterizes these cases and is part of the spectrum of a SARS-CoV-2-related syndromes called multisystem inflammatory syndrome (MIS-C). Case Presentation: We report the case of a child with severe cardiovascular impairment due to MIS-C who developed cardiogenic shock secondary to acute myocarditis. The pathophysiology of myocardial outcomes caused by MIS-C remains unclear. Conclusions: We intend to contribute to new prospective studies on the early diagnosis, clinical management, and follow-up of patients with severe cardiovascular impairment secondary to infection with SARS-CoV-2.

scholarly journals A Case of Incomplete and Atypical Kawasaki Disease Presenting with Retropharyngeal Involvement

2019 ◽  
Vol 16 (18) ◽  
pp. 3262
Author(s):  
Chiara Isidori ◽  
Lisa Sebastiani ◽  
Susanna Esposito
Keyword(s):  
Kawasaki Disease ◽  
Delayed Diagnosis ◽  
Cervical Lymphadenopathy ◽  
Intravenous Immunoglobulins ◽  
Case Presentation ◽  
Clinical Criteria ◽  
Atypical Kawasaki Disease ◽  
Laboratory Examinations ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Background: Kawasaki disease (KD) is a childhood acute febrile vasculitis of unknown aetiology. The diagnosis is based on clinical criteria, including unilateral cervical lymphadenopathy, which is the only presenting symptom associated with fever in 12% of cases. A prompt differential diagnosis distinguishing KD from infective lymphadenitis is therefore necessary to avoid incorrect and delayed diagnosis and the risk of cardiovascular sequelae. Case presentation: We describe the case of a 4 years old boy presenting with febrile right cervical lymphadenopathy, in which the unresponsiveness to broad-spectrum antibiotics, the following onset of other characteristic clinical features and the evidence on the magnetic resonance imaging (MRI) of retropharyngeal inflammation led to the diagnosis of incomplete and atypical KD. On day 8 of hospitalisation (i.e., 13 days after the onset of symptoms), one dose of intravenous immunoglobulins (IVIG; 2 g/kg) was administered with rapid defervescence, and acetylsalicylic acid (4 mg/kg/day) was started and continued at home for a total of 8 weeks. Laboratory examinations revealed a reduction in the white blood cell count and the levels of inflammatory markers, thrombocytosis, and persistently negative echocardiography. Clinically, we observed a gradual reduction of the right-side neck swelling. Fifteen days after discharge, the MRI of the neck showed a regression of the laterocervical lymphadenopathy and a resolution of the infiltration of the parapharyngeal and retropharyngeal spaces. Conclusion: Head and neck manifestations can be early presentations of KD, which is frequently misdiagnosed as suppurative lymphadenitis or retropharyngeal infection. A growing awareness of the several possible presentations of KD is therefore necessary. Computed tomography (CT) or MRI can be utilised to facilitate the diagnosis.

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