P398 A CASE OF MIS–C: SARS–COV2 AND MYOCARDITIS IN PEDIATRIC AGE

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Abstract A 12–year–old patient with paucisymptomatic SARS–COV2 infection in November 2020 with negative swab after 10 days. After 3 weeks access to pediatric emergency room for fever, maculo–papular rash on the trunk, conjunctivitis, nausea and abdominal pain: evidence of thrombocytopenia, increased CPK, LDH, AST and inflammation markers. She starts antibiotic therapy for suspected sepsis. After 24 hours asthenia, general illness, hypotension and tachycardia: echocardium with diffuse hypokinesia of the left ventricle (EF 35%); worsening of thrombocytopenia, D–Dimer, BNP and CPK increase, hyponatremia, troponin positivity, ATIII reduction; negative viral markers. On the basis of the most recent literature, the diagnosis of MIS–C is made, a post–infection SARS–COV2 multisystemic inflammatory syndrome. After discussion with the 3rd level SARS–COV2 Pediatric Center, the following therapy begins: iv diuretic, iv cortisone, sc heparin, iv immunoglobulins, Anakinra. For a progressive clinical worsening by cardiogenic shock with evolution to DIC, she is transferred by military plane to the pediatric intensive care of 3rd level SARS–COV2 Center. The patient is subjected to mechanical ventilation, therapy with inotropes (adrenaline and milrinone) and CRRT ultrafiltration in order to reduce the excessive levels of inflammatory mediators responsible for rapid multiorgan failure. After 4 days, haemodynamic parameters improvement (EF 50%); sartan and low dose diuretic have been started because of the presence of diastolic dysfunction. Discharge after 1 month of hospitalization with good clinical and haemodynamic stability. After 6 months from myocarditis onset with cardiogenic shock in MIS–C, cardiac MRI with evidence of EF 57% and small area of delayed enhancement on the anterior IVS with non–ischemic pattern, no longer present by imaging after 1 year by acute event. Currently the patient reports subjective well–being by the regular follow–up without arrhythmias by Holter monitoring. SARS–COV2 post–infection multisystemic inflammatory syndrome (MIS–C) represents a serious complication with possible myocardial involvement also following a paucysymptomatic infection as in the described case. What happened shows us that SARS–COV2 infection is still a devious clinical entity that needs close follow–up in the short and long term.