RESUMO
In the list of top 10 causes of death worldwide in 2019, stroke ranks number two, with a recent uptick in incidence involving younger adults. While common risk factors like tobacco use, hypertension, diabetes, and atrial fibrillation have been well studied, recent reports have also linked paroxysmal supraventricular tachycardia (PSVT) with strokes. This case highlights a rare presentation of a 25-year-old female who suffered an ischemic stroke shortly after undergoing chemical cardioversion for sustained SVT. To date, there are only three documented cases reporting an ischemic event following shortly after cardioversion of SVT, all confined to the pediatric population. Currently, there is limited evidence to guide the management of these complex patients. This case presents a valuable discussion regarding the futility or efficacy of imaging prior to cardioversion of SVT as well as furthers the conversation behind the theorized mechanisms linking PSVT and strokes.
RESUMO
Background: Pediatric inflammatory multisystem syndrome temporarily associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PIMS-TS) is an acute complication of previous SARS-CoV-2 exposure. The relationship between inflammatory markers and anti-inflammatory medication in PIMS-TS is unknown. We retrospectively investigated the relationship between demographics, biomarkers, treatment, and length of stay (LOS) in this novel disease. Methods: We reviewed the case notes and blood tests of all patients who met the Royal College of Paediatrics and Child Health diagnostic criteria for PIMS-TS at a large tertiary center in the United Kingdom. Biomarker trajectories were modeled using log linear mixed effects, and factors affecting LOS in hospital were evaluated using multiple regression. Results: Between March 2020 and May 2022, a total of 56 patients attended Sheffield Children's Hospital with PIMS-TS, 70% male. Mean age was 7.4 ± 3.7 years and mean LOS 8.7 ± 4.5 days with 50% requiring intensive care and 20% requiring inotropes. Older males had shorter LOS than younger males (P = 0.04), not seen in females. Treatment included intravenous glucocorticoids in 93%, intravenous immunoglobulins (IVIG) in 77%, Anakinra in 11%, and infliximab in 1.8%. Biomarkers correlated poorly with trajectories that peaked at different times. C-reactive protein peaked first after median 1.3 days postadmission; while LFT's and neutrophils peaked after 3 days. Age had a large effect on some biomarkers, with older children having larger troponin and ferritin, and lower lymphocytes and platelets. Cumulative dose of glucocorticoids and IVIG had a statistically significant effect on some biomarkers, but effect size was small. Conclusions: The heterogenous nature of PIMS-TS highlights the importance of a multidisciplinary approach. Worse inflammatory markers in older children within our cohort may be an indication of a different disease process occurring at different ages. Future work to investigate the association between age and troponin and ferritin in hyperinflammatory states is warranted.
