A case report of multisystem inflammatory syndrome in children complicated by SARS-CoV-2 infection / 中国热带医学

ABSTRACT

@#Abstract: Objective　To investigate the clinical manifestations, diagnosis, treatment and prognosis of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) with multisystem organ failure, and to analyze the differences between the syndrome resembling Kawasaki disease and Kawasaki disease. Methods We report a case of child diagnosed with SARS-CoV-2 infection who developed MIS-C with multi-organ failure. Literature was reviewed to further discuss clinical symptoms, diagnosis, treatment, and prognosis of MIS-C. Results The patient 's condition progressed rapidly and was severe, with acute kidney injury at admission, presenting with urine output of 0 mL in 8 hours, serum creatinine of 675.1 μmol/L, urea nitrogen of 38.2 mmol/L, creatine kinase 4 932 U/L, along with continuously elevated serum amylase, peaking at 5 809.7 U/L, aspartate aminotransferase of 995 U/L, alanine aminotransferase of 240 U/L, and frequent vomiting. The patient was categorized as critically ill. The confirmed patient with MIS-C was managed in pediatric intensive care units (PICU), received early continuous blood purification, jejunal tube feeding, and combined treatment with intravenous methylprednisolone pulse and human immunoglobulin for intravenous injection (IVIG), resulting in complete recovery and discharge. Through literature review, it can be analyzed that MIS-C is systemic inflammatory response characterized by multi-organ dysfunction from a cytokine storm, which differentiates it from Kawasaki disease characterized by acute systemic vasculitis triggered by infectious factors, ultimately leading to cardiovascular accidents as the main cause of death.Conclusions When fever (≥38 ℃) persists for at least 24 hours, accompanied by high inflammatory symptoms and dysfunction in two or more systems, requiring intensive care treatment, and there is evidence of SARS-CoV-2 infection, MIS-C should be diagnosed early, and intervention and treatment should be initiated promptly to achieve favorable outcomes.