Severe Bone Marrow Suppression and kidney Injury Due to Multisystem Inflammatory Syndrome in Children: A Case Report

Abstract

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of COVID-19, and bone marrow suppression is an exceedingly rare manifestation of MIS-C. This report presents a 10-year-old boy with periorbital ecchymosis, lethargy, and a history of fever and cough, who was diagnosed with MIS-C accompanied by severe bone marrow suppression. Case Presentation: A 10-year-old boy was referred to our hospital with complaints of ecchymosis around the eyelids, especially the upper eyelids, and lethargy. He also reported a history of cough, fever, and bone pain over the past 10 days. Although fever and cough had subsided, the patient remained lethargic. Laboratory studies were performed, and a complete blood count (CBC) revealed severe bone marrow suppression. Additional tests showed markedly elevated urea and creatinine levels, severe hyperphosphatemia, and severe hyperuricemia, indicating renal failure. Given the laboratory findings and his lethargic condition, the patient was hospitalized and underwent hemodialysis. Blood products, including packed red cells and platelet units, were transfused following hematology consultation. Further laboratory tests ruled out rheumatological conditions, with all rheumatological tests reported as normal. However, Interleukin-6 (IL-6) and fibrinogen levels were significantly elevated, and the COVID-19 PCR test was positive. Based on these findings, the diagnosis of MIS-C was established. Treatment with remdesivir and methylprednisolone pulse therapy was initiated. Other potential infectious causes of bone marrow suppression, such as leishmaniasis, were excluded due to normal test results and a normal CBC performed one week prior to the onset of clinical symptoms. Following the completion of treatment, the hematological and nephrological complications resolved, and the patient was discharged in good condition. He remains under regular follow-up. Conclusions: Multisystem inflammatory syndrome in children can lead to bone marrow suppression, and a combination of remdesivir and methylprednisolone appears to be an effective treatment for managing this condition.