Hepatic vein thrombosis in a child with COVID-19: clinical case

Authors

DOI:

https://doi.org/10.15574/SP.2022.123.94

Keywords:

COVID-19, hepatic vein thrombosis, thromboinflammation, multisystem inflammatory syndrome (MIS-C)

Abstract

Predisposition to venous thromboembolism is characteristic of SARS-CoV-2 infection, as thromboinflammation is one of the leading parts in the pathogenesis of COVID-19 and the cause of life-threatening conditions and death.

We presented a clinical case of hepatic vein thrombosis in a 1-year-9-month-old girl with COVID-19 who met the MIS-C criteria. The girl was admitted to the hospital on the first day of the disease with complaints of repeated vomiting, fever up to 38.5-390C, severe weakness, refusal to eat and drink, a slight cough. The severity of the patient’s condition was due to fever and intoxication syndrome. There were manifestations of acute pharyngitis. In the first days we observed leukocytosis with neutrophilia, moderate lymphopenia, elevated levels of C-reactive protein, hypoalbuminemia, accelerated ESR. On admissiona rapid antigen test and PCR for SARS-CoV-2 were negative. Abdominal ultrasound revealed microthrombosis of the hepatic veins with inflammatory changes in the vessels, a small amount of free fluid in the abdominal cavity. Echocardiography detected the presence of fluid in the pericardial cavity. The level of D-dimer was increased to 943 ng/ml. Subsequently, COVID-19 was confirmed by serological testing.

Conclusions. Thus, thrombosis of the veins of the internal organs, despite their rarity in childhood, can occur in COVID-19 and MIS-C and indicate thromboinflammation, which requires caution about their possible development and the correct diagnostic algorithm. Determination of the level of D-dimer and Doppler ultrasound examination of the abdominal cavity allows the diagnosis of thrombotic events in splanchnic organs in patients with COVID-19 and provide adequate treatment.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

References

Ashkenazi-Hoffnung L, Shmueli E, Ehrlich S et al. (2021, Dec). Long COVID in Children: Observations From a Designated Pediatric Clinic. Pediatr Infect Dis J. 40 (12): e509-e511. https://doi.org/10.1097/INF.0000000000003285; PMid:34371507 PMCid:PMC8575093

Boyarchuk O, Predyk L, Yuryk I. (2021). COVID-19 in patients with juvenile idiopathic arthritis: frequency and severity. Reumatologia. 59 (3): 197-199. https://doi.org/10.5114/reum.2021.107590; PMid:34538947 PMCid:PMC8436806

CDC. (2020). Emergency preparedness and response: health alert network. Centers for Disease Control and Prevention. URL: https://emergency.cdc.gov/han/2020/han00432.asp.

Colmenero I, Santonja C, Alonso-Riaño M et al. (2020). SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. Br J Dermatol. 183: 729-737. https://doi.org/10.1111/bjd.19327; PMid:32562567 PMCid:PMC7323219

Domínguez-Rodríguez S, Villaverde S, Sanz-Santaeufemia FJ et al. (2021). A Bayesian Model to Predict COVID-19 Severity in Children. Pediatr Infect Dis J. 40 (8): e287-e293. https://doi.org/10.1097/INF.0000000000003204; PMid:34250967

Ekdahl KN, Teramura Y, Asif S et al. (2015). Thromboinflammation in Therapeutic Medicine. Adv Exp Med Biol. 865: 3-17. https://doi.org/10.1007/978-3-319-18603-0_1; PMid:26306440

Giacomet V, Barcellini L, Stracuzzi M et al. (2020). Gastrointestinal Symptoms in Severe COVID-19 Children. Pediatr Infect Dis J. 39 (10): e317-e320. https://doi.org/10.1097/INF.0000000000002843; PMid:32932333

Henderson LA, Canna SW, Friedman KG et al. (2021). American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol. 73 (4): e13-e29. https://doi.org/10.1002/art.41616; PMid:33277976 PMCid:PMC8559788

Hoang A, Chorath K, Moreira A et al. (2020). COVID-19 in 7780 pediatric patients: a systematic review. Clinical Medicine. 24: 100433. https://doi.org/10.1016/j.eclinm.2020.100433; PMid:32766542 PMCid:PMC7318942

Kanmaniraja D, Kurian J, Holder J et al. (2021). Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children. Clin Imaging. 80: 88-110. https://doi.org/10.1016/j.clinimag.2021.06.025; PMid:34298343 PMCid:PMC8223038

Lai CC, Ko WC, Chen CJ et al. (2021). COVID-19 vaccines and thrombosis with thrombocytopenia syndrome. Expert Rev Vaccines. 20 (8): 1027-1035. https://doi.org/10.1080/14760584.2021.1949294; PMid:34176415

Perry RJ, Tamborska A, Singh B et al. (2021). Cerebral venous thrombosis after vaccination against COVID-19 in the UK: a multicentre cohort study. Lancet. 398 (10306): 1147-1156. https://doi.org/10.1016/S0140-6736(21)01608-1

Royal College of Paediatrics and Child Health. (2020). Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19. URL: https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims.

Sancho-Shimizu V, Brodin P, Cobat A et al. (2021). SARS-CoV-2-related MIS-C: A key to the viral and genetic causes of Kawasaki disease? J Exp Med. 218 (6): e20210446. https://doi.org/10.1084/jem.20210446; PMid:33904890 PMCid:PMC8080850

Schulman S, Hu Y, Konstantinides S. (2020). Venous Thromboembolism in COVID-19. Thromb Haemost. 120 (12): 1642-1653. https://doi.org/10.1055/s-0040-1718532; PMid:33099284 PMCid:PMC7869046

Toptan T, Ciesek S, Hoehl S. (2021). Pediatrics and COVID-19. Adv Exp Med Biol. 1318: 197-208. https://doi.org/10.1007/978-3-030-63761-3_12; PMid:33973180

Varga Z, Flammer AJ, Steiger P et al. (2020). Endothelial cell infection and endotheliitis in COVID-19. Lancet. 395 (10234): 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5

Whitworth H, Sartain SE, Kumar R et al. (2021). Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C. Blood. 138 (2): 190-198. https://doi.org/10.1182/blood.2020010218; PMid:33895804 PMCid:PMC8079262

World Health Organization. (2020). Multisystem inflammatory syndrome in children and adolescents with COVID-19. URL: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.

Zaffanello M, Piacentini G, Nosetti L, Ganzarolli S, Franchini M. (2021). Thrombotic risk in children with COVID-19 infection: A systematic review of the literature. Thromb Res. 205: 92-98. https://doi.org/10.1016/j.thromres.2021.07.011; PMid:34293539 PMCid:PMC8284063

Zhang L, Feng X, Zhang D et al. (2020). Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 42 (2): 114-128. https://doi.org/10.1161/CIRCULATIONAHA.120.046702; PMid:32421381

Published

2022-04-30