Abstract
The novel coronavirus disease (COVID-19) may induce multisystem inflammatory syndrome (MIS) in children, which may be associated with Kawasaki-like disease and cardiac injury. In this study, we presented three male adolescents with MIS and myocardial injury admitted to the hospital during the peak of COVID-19 pandemic. All of the three patients had a history of fever, gastrointestinal symptoms, polymorph rash, non-exudative conjunctivitis, and signs of acute myocarditis (AM). One of them had renal failure. Previously, they did not have an acute infection. Upon admission, they were hypotensive and tachycardic. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on reverse transcription-polymerase chain reaction (PCR) assay was negative, but neutralizing viral antibodies were positive. In combination with blood tests, electrocardiogram, echocardiography, and computerized tomography, a MIS associated with acute myocarditis with mild to moderate systolic dysfunction and dilated coronary arteries were diagnosed. Two of three patients had shock syndrome and required inotropic support. All patients were treated with intravenous immunoglobulins (Ig). The second patient had a fever up to 102.2°F (39°C) 3 days after intravenous Ig. Further, he was treated according to protocols for refractory Kawasaki disease, with an intravenous methylprednisolone pulse therapy and aspirin. After a few hours, he became afebrile and the clinical signs disappeared. The favorable short-term outcome may reflect early recognition and adequate therapy; however, the long-term outcomes are currently unknown.
Highlights
Acute myocarditis (AM) is an inflammatory disease and cardiotropic viruses are the most commonly identified etiological factor [1], but less is known about the cardiac involvement in novel coronavirus disease (COVID-19)
Our report presents three male adolescents who were admitted to our hospital within 2 months from the beginning and at the height of the SARS-CoV-2 epidemic in Serbia, with similar clinical presentation and clinical course
Patients with multisystem inflammatory syndrome (MIS)-C were older in comparison to patients with classic Kawasaki disease (KD) [5,6,7,8,9], as well as in our cases
Summary
Acute myocarditis (AM) is an inflammatory disease and cardiotropic viruses are the most commonly identified etiological factor [1], but less is known about the cardiac involvement in novel coronavirus disease (COVID-19). A healthy 14-year-old boy was transferred to our institute due to renal failure caused by fever of 104°F, diarrhea, and vomiting for 7 previous days He did not have signs of COVID-19. A healthy 14-year-old boy was admitted due to fever, vomiting, and headache for 7 previous days His medical history did not reveal signs of acute infection. His vital parameters and laboratory analysis on admission were presented in Tables 1 and 2. Laboratory analysis before the transfer showed elevated cTnI value He had anamnestic data about contacts with SARS-CoV-2 positive persons. TTE after IVIG treatment showed normalization of systolic function (LVEF 68%) and diameter of coronary arteries (LCA, RCA 3 mm).
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