Lipid profile and pulmonary ultrasound in PIMS. Three case reports

Abstract

SARS-CoV-2 infection in children often occurs in an asymptomatic and/or paucisymptomatic manner. However, a multisystem inflammatory syndrome (MIS-C) may occur in the 4-6 weeks following the infection. This syndrome is triggered by the release of cytokines, due to an abnormal immune response to the infection. The recent literature described the different clinical spectrum and phenotypic features of MIS-C, but there are few data about the characteristics of the syndrome after clinical recovery phase. The description of three cases of post-SARS-CoV-2 infection syndrome in children aims to providing evidence of the relevant follow-up phase, besides the onset symptoms and the clinical course. In two cases, the onset clinical symptoms were similar to Kawasaki syndrome, while in the third one neurological impairment was prevalent. No association with gastrointestinal symptoms was found, while the increase in the inflammation and phlogosis indices was constant. Cardiac involvement was never reported, despite the positivity of myocardial distress markers, while the lung ultrasound showed signs of interstitial disease, even though there were no clinical respiratory signs. In all cases, the course was benign with improvement of clinical conditions within about 5 days and normalization of phlogosis indices and lung involvement after about 30 days from the onset. The lipid profile at onset was characterized by an increase in triglyceride levels, thus suggesting a relation with the inflammation indices, followed by an increase in the total cholesterol - probably related to the immune response - after the clinical healing phase, contrary to what has been stated by the current literature.