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Cardiac manifestations and short-term outcomes of multisystem inflammatory syndrome in Middle Eastern children during the COVID-19 pandemic: a case series

Published online by Cambridge University Press:  17 June 2021

Theresia E. Tannoury ,
Ziad R. Bulbul Open the ORCID record for Ziad R. Bulbul [Opens in a new window]  and
Fadi F. Bitar Open the ORCID record for Fadi F. Bitar [Opens in a new window]
Theresia E. Tannoury
Affiliation:
Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Ziad R. Bulbul*
Affiliation:
Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Fadi F. Bitar
Affiliation:
Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
*
Author for correspondence: Dr Z. Bulbul, MD, Department of Pediatrics and Adolescent Medicine, American University of Beirut, PO Box 11-0236, Riad-El Solh St., Beirut, 1107 2020, Lebanon. Tel: +9 617 679 3838; Fax: +961370781. E-mail: [email protected].
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Abstract

We herein report on a series of four patients presented to our tertiary care centre with features of multisystem inflammatory syndrome in children and cardiac involvement. Two of our patients had recent exposure to a COVID-19-positive patient, one had recent documented infection, and another had no known positive contact. All the patients were tested positive for severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibody at the time of presentation. All of them fulfilled the diagnostic criteria according to the World Health Organization Centers for Disease Control or the British guidelines for MIS-C (fever for ≥3 days, multisystem involvement (at least two), elevated markers of inflammation, and no other alternative diagnosis).

Cardiac involvement was variable ranging from isolated ectasia of the coronary arteries to full-blown pancarditis such as severe biventricular dysfunction, multi-valvar involvement, and pericardial effusion.

All our patients received intravenous immunoglobulin (2 g/kg), methylprednisolone, and aspirin and some required inotropic support and ICU admission.

Remarkably, all our patients showed significant improvement in their cardiac disease within a few days as evident on serial echocardiographic evaluation. However, we stress the need for long-term follow-up as one of our patients demonstrated mild LV myocardial scarring as evident by gadolinium late enhancement on a cardiac MRI.

Keywords

Multisystem inflammatory syndrome in children (MIS-C)cardiac manifestationsCOVID-19coronary involvementmyocardial dysfunction
Type
Brief Report
Information
Cardiology in the Young , Volume 32 , Issue 1 , January 2022 , pp. 165 - 168
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Rabinowicz, S, Leshem, E, Pessach, IM. COVID-19 in the pediatric population-review and current evidence. Curr Infect Dis Rep 2020; 22: 29.10.1007/s11908-020-00739-6CrossRefGoogle ScholarPubMed
World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19, 2020. Retrieved May 15, 2020, from https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 Google Scholar
Narayanan, SN, Ahamed, MZ, Safia, M, et al. Cardiovascular involvement in Kawasaki disease. Indian Pediatr 2005; 42: 918–922.Google ScholarPubMed
Feldstein, LR, Rose, EB, Horwitz, SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383: 334–346.CrossRefGoogle ScholarPubMed
Davies, P, Evans, C, Kanthimathinathan, HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicenter observational study. Lancet Child Adolesc Health 2020; 4: 669–677.10.1016/S2352-4642(20)30215-7CrossRefGoogle Scholar
Almoosa, ZA, Al Ameer, HH, AlKadhem, SM, et al. Multisystem inflammatory syndrome in children, the real disease of COVID-19 in pediatrics – a multicenter case series from Al-Ahsa, Saudi Arabia. Cureus 2020; 12: e11064.Google Scholar
Kaushik, S, Aydin, SI, Derespina, KR, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): a multi-institutional study from New York City. J Pediatr 2020; 224: 24–29.10.1016/j.jpeds.2020.06.045CrossRefGoogle ScholarPubMed
Chiotos, K, Bassiri, H, Behrens, EM, et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatric Infect Dis Soc 2020; 9: 393–398.10.1093/jpids/piaa069CrossRefGoogle ScholarPubMed
Tops, LF, Delgado, V, Marsan, NA, Bax, JJ. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail 2017; 19: 307–313.10.1002/ejhf.694CrossRefGoogle ScholarPubMed
Moran, AM, Newburger, JW, Sanders, SP, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gamma-globulin. Am Heart J 2000; 139 (Pt 1): 217–223.Google ScholarPubMed
Blondiaux, E, Parisot, P, Redheuil, A, et al. Cardiac MRI in children with multisystem inflammatory syndrome associated with COVID-19. Radiology 2020; 297: E283–E288.CrossRefGoogle ScholarPubMed
Bratis, K, Hachmann, P, Child, N, et al. Cardiac magnetic resonance feature tracking in Kawasaki disease convalescence. Ann Pediatr Cardiol 2017; 10: 18–25.10.4103/0974-2069.197046CrossRefGoogle ScholarPubMed
Sperotto, F, et al. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr 2021; 180: 307–322.10.1007/s00431-020-03766-6CrossRefGoogle ScholarPubMed