Difficulty in diagnosing and treating a child with multisystem inflammatory syndrome: a Case report

Abstract

This clinical observation is an example to show the complexity of diagnosing and treating children with SARS-CoV-2-associated multisystem inflammatory syndrome.
 A 17-year-old patient who had a mild form of COVID-19 two weeks ago had a fever again and felt severe abdominal pain, and his general condition deteriorated rapidly. Moreover, on the fifth day from the onset of the disease, a child from the district hospital was admitted to the Ivano-Matreninsky Childrens Hospital in critical condition. Due to peritoneal symptoms, a diagnostic laparoscopy was performed to exclude acute surgical diseases which revealed mesadenitis and hydroperitoneum. Subsequently, the patient had a prolonged fever, severe multiple organ failure developed, including myocarditis with damage to the conduction system of the heart and a marked decrease in the left ventricular ejection fraction, bilateral pneumonia, hydroperitoneum and hydrothorax, acute kidney injury, lymphopenia, thrombocytopenia, coagulopathy, increased markers of inflammation. Non-invasive artificial lung ventilation was performed for 3 d. On day 10, an atrial temporary pacing system was installed, removed 11 d after heart rhythm normalization, and the pleural cavity was drained due to spontaneous pneumothorax. There was a gradual positive trend in respiratory status, the state of the cardiovascular system, normalization of laboratory parameters, and a decrease in inflammation markers. The patient was discharged from the hospital in a satisfactory condition on day 39.
 This clinical case demonstrates a severe course of childhood inflammatory, multisystem syndrome with multiple organ failure. The peculiarities of the case include the severity of abdominal pain syndrome, requiring laparoscopy, impaired cardiac activity, and requiring a pacemaker for 11 days.