Letter by Cardenas Suri and Jimomila Bening Regarding Article, “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic”

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HomeCirculationVol. 143, No. 10Letter by Cardenas Suri and Jimomila Bening Regarding Article, “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Cardenas Suri and Jimomila Bening Regarding Article, “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic” Hisyovi Cardenas Suri and David Jimomila Bening Hisyovi Cardenas SuriHisyovi Cardenas Suri https://orcid.org/0000-0002-0933-8716 Tamale Teaching Hospital, Ghana. Search for more papers by this author and David Jimomila BeningDavid Jimomila Bening https://orcid.org/0000-0002-5877-4741 Tamale Teaching Hospital, Ghana. Search for more papers by this author Originally published8 Mar 2021https://doi.org/10.1161/CIRCULATIONAHA.120.049139Circulation. 2021;143:e757–e758To the Editor:We recently read the article in Circulation by Belhadjer et al1 about the multisystem inflammatory syndrome and the relation with cardiac events. This problem goes far beyond the cardiac problem to include other systemic conditions.The presence of several reports of hyperinflamatory syndrome in children, even recognized and with diagnostic criteria according to a report by the World Health Organization and Centers for Disease Control and Prevention like multisystem inflammatory syndrome in children and adolescents,2 has led us to review various diseases that present with phenomena of organ failure, thrombosis, cytokine storm, and elevation of ferritin, mainly involving the lung, heart, kidney, skin, and so forth. Among the possible causes, we find a common entity, the catastrophic antiphospholipid antibody syndrome.In the CAPS Registry (Catastrophic Antiphospholipid Antibody Syndrome), catastrophic antiphospholipid antibody syndrome as the initial manifestation of antiphospholipid syndrome occurred in 86.6% of children, with infections being the triggering factor in 60.9% of the cases. Cardiac involvement was present in 57.4% of children and included cardiac failure, heart valve lesions, lung (63.0%), skin (37.0%), and gastrointestinal (17.4%).3Infections in children are more frequent than in adults, which have been shown to play a role in the theory of “molecular mimicry” (molecular imitation), where certain viruses and bacteria that have an amino acid sequence similar to that of B2-GP1 result in an immune response producing antiphospholipid antibodies. B2-GP1 could activate the immune response through interaction with a membrane receptor (toll-like receptors), and from this a series of signals are generated that increase the production of proinflammatory cytokines.4The medical community recognizes the multisystem inflammatory syndrome, but most do not agree with the diagnosis of Kawasaki disease. In addition, the patients do not meet the diagnostic criteria to support macrophage activation syndrome; however, clinically the patients meet the catastrophic antiphospholipid antibody syndrome criteria,4 and it would only be necessary to indicate antinuclear antibodies to confirm this diagnosis.Disclosures None.Footnoteshttps://www.ahajournals.org/journal/circ