Multisystem inflammatory syndrome complicated by pulmonary embolism in a child
DOI:
https://doi.org/10.15574/SP.2023.134.142Keywords:
multisystem inflammatory syndrome, children, pulmonary embolism, primary thrombophilia, anticoagulant therapyAbstract
Purpose - to present a clinical case of a particular complication of post-COVID multisystem inflammatory syndrome (MIS) - pulmonary embolism (PE) which developed due to primary hereditary thrombophilia in a child for better understanding of the MIS evolution and prognosis in children (MIS-C).
Case report. In an 11-year-old boy who previously had no hemorrhagic manifestations, the first symptoms of the disease occurred in the form of fever and a hemorrhagic rash on the lower extremities. Later, he developed signs of respiratory failure, his condition worsened, and bilateral community-acquired viral pneumonia caused by COVID-19 was diagnosed. The child presented with post-COVID MIS manifested as PE, which caused further genetic examinations for hereditary thrombophilia. Primary thrombophilia was detected (F2 gene - prothrombin (20210 G>A) D68.5). Concomitant hereditary pathology was probably the reason for a severe course of the infection and the development of a complication in the form of PE requiring intensive and long-term anticoagulant therapy.
Conclusions. In case of PE detection, especially in young patients, examinations to confirm or rule out hereditary or acquired thrombophilia are required, that defines recurrent venous thromboembolism prevention programs. This clinical case report is a contribution to the study on the issues of MIS-C, defining links between pulmonary complications (transient or persistent) and serious sequelae in the future.
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
Abrams JY, Godfred-Cato SE, Oster ME, Chow EJ, Koumans EH, Bryant B et al. (2020). Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. J Pediatr. 226: 45-54.e1. https://doi.org/10.1016/j.jpeds.2020.08.003; PMid:32768466 PMCid:PMC7403869
Arachchillage DJ, Mackillop L, Chandratheva A, Motawani J, MacCallum P, Laffan M. (2022). Thrombophilia testing: A British Society for Haematology guideline. Br J Haematol. 198 (3): 443-458. Epub 2022 May 29. https://doi.org/10.1111/bjh.18239; PMid:35645034 PMCid:PMC9542828
Boulet SL, Grosse SD, Thornburg CD, Yusuf H, Tsai J, Hooper WC. (2012). Trends in venous thromboembolism-related hospitalizations, 1994-2009. Pediatrics. 130 (4): e812-20. Epub 2012 Sep 17. https://doi.org/10.1542/peds.2012-0267; PMid:22987875 PMCid:PMC4527304
Branchford BR, Carpenter SL. (2018). The Role of Inflammation in Venous Thromboembolism. Front Pediatr. 23; 6: 142. https://doi.org/10.3389/fped.2018.00142; PMid:29876337 PMCid:PMC5974100
Celkan T, Dikme G. (2018). Thrombosis in children: Which test to whom, when and how much necessary? Turk Pediatri Ars. 1; 53 (1): 1-9. https://doi.org/10.5152/TurkPediatriArs.2018.2586; PMid:30083068 PMCid:PMC6070222
Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L et al. (2020). The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. The National Library of Medicine (NLM) has renamed the COVID-19 Public Health Emergency Initiative as the PMC COVID-19 Collection. 12; 183 (4): 968-981.e7. https://doi.org/10.1016/j.cell.2020.09.016; PMid:32966765 PMCid:PMC7474869
Dain AS, Raffini L, Whitworth H. (2022). Thrombotic events in critically ill children with coronavirus disease 2019 or multisystem inflammatory syndrome in children. Curr Opin Pediatr. 1; 34 (3): 261-267. https://doi.org/10.1097/MOP.0000000000001130; PMid:35634699 PMCid:PMC9197313
Ebina-Shibuya R, Namkoong H, Shibuya Y, Horita N. (2020). Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Insights from simultaneous familial Kawasaki Disease cases. Int J Infect Dis. 97: 371-373. https://doi.org/10.1016/j.ijid.2020.06.014; PMid:32553716 PMCid:PMC7293840
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al. (2020). Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 23; 383 (4): 334-346. https://doi.org/10.1056/NEJMoa2021680; PMid:32598831 PMCid:PMC7346765
Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J et al. (2020). California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 14; 69 (32): 1074-1080. https://doi.org/10.15585/mmwr.mm6932e2; PMid:32790663 PMCid:PMC7440126
Gruber CN, Patel RS, Trachtman R, Lepow L, Amanat F, Krammer F et al. (2020). Mapping Systemic Inflammation and Antibody Responses in Multisystem Inflammatory Syndrome in Children (MIS-C). PMC COVID-19 Collection. 12; 183 (4): 982-995.e14. https://doi.org/10.1016/j.cell.2020.09.034; PMid:32991843 PMCid:PMC7489877
Harahsheh AS, Krishnan A, De Biasi RL, Olivieri LJ, Spurney C, Donofrio MT et al. (2021). Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children. Cardiol Young. 5: 1-9. https://doi.org/10.1017/S1047951121003024; PMid:34348808 PMCid:PMC8816963
Hedegaard SS, Klein AC, Hvas AM. (2018). The significance of thrombophilia in paediatric thromboembolism. Scand J Clin Lab Invest. 78 (7-8): 551-555. Epub 2018 Sep 27. https://doi.org/10.1080/00365513.2018.1517418; PMid:30261760
Hejazi OI, Loke YH, Harahsheh AS. (2021). Short-term Cardiovascular Complications of Multi-system Inflammatory Syndrome in Children (MIS-C) in Adolescents and Children. Curr Pediatr Rep. 22: 1-11. https://doi.org/10.1007/s40124-021-00258-5; PMid:34703656 PMCid:PMC8531914
Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H 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
Kaushik S, Aydin SI, Derespina KR, Bansal PB, Kowalsky S, Trachtman R et al. (2020). Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection (MIS-C): A Multi-institutional Study from New York City. J Pediatr. 224: 24-29. https://doi.org/10.1016/j.jpeds.2020.06.045; PMid:32553861 PMCid:PMC7293760
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP et al. (2019). The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 9; 54 (3): 1901647. https://doi.org/10.1183/13993003.01647-2019; PMid:31473594
Ministry of Health of Ukraine. (2020). On Amendments to the Protocol "Providing Medical Aid for the Treatment of the Coronavirus Disease (COVID-19)". Order of the Ministry of Health of Ukraine of April 2, 2020 No. 762 (as amended by the Order of the Ministry of Health of Ukraine of December 31, 2020 No. 3094). URL: https://zakon.rada.gov.ua/rada/show/v3094282-20.
Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J. (2021). Gupta A. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev. 38: 51-57. https://doi.org/10.1016/j.prrv.2020.08.001; PMid:32891582 PMCid:PMC7417920
Santaniello M, Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R et al. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 1; 174 (9): 882-889. https://doi.org/10.1001/jamapediatrics.2020.1467; PMid:32320004
Sciensano. (2020). Interim clinical Guidance for adults with suspected or confirmed COVID-19 in Belgium 1 December 2020 Version 15 Addition 2 December 2020. URL: https://covid-19.sciensano.be/sites/default/files/Covid19/COVID19_InterimGuidelines_Treatment_ENG.pdf.
Singh H, Kaur H, Singh K, Sen CK. (2021). Cutaneous Manifestations of COVID-19: A Systematic Review. Adv Wound Care (New Rochelle). 10 (2): 51-80. https://doi.org/10.1089/wound.2020.1309; PMid:33035150 PMCid:PMC8020517
Sperotto F, Friedman KG, Son MBF, Vander Pluym CJ, Newburger JW, Dionne A. (2021). Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 180 (2): 307-322. Epub 2020 Aug 15. https://doi.org/10.1007/s00431-020-03766-6; PMid:32803422 PMCid:PMC7429125
Stevens SM, Woller SC, Bauer KA, Kasthuri R, Cushman M, Streiff M et al. (2016). Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis. 41 (1): 154-64. https://doi.org/10.1007/s11239-015-1316-1; PMid:26780744 PMCid:PMC4715840
Vazquez F, Rodger M, Carrier M, Le Gal G, Reny JL, Sofi F et al. (2015). G20210A mutation and lower extremity peripheral arterial disease: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 50 (2): 232-40. Epub 2015 Jun 16. https://doi.org/10.1016/j.ejvs.2015.04.033; PMid:26092622
Wanga V, Gerdes ME, Shi DS, Choudhary R, Dulski TM, Hsu S et al. (2021). Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 - Six Hospitals, United States, July-August 2021. MMWR Morb Mortal Wkly Rep. 31; 70 (5152): 1766-1772. doi: 10.15585/mmwr.mm705152a3. Erratum in: MMWR Morb Mortal Wkly Rep. 2022 Feb 04; 71 (5): 185. https://doi.org/10.15585/mmwr.mm7105a5; PMid:35113848 PMCid:PMC8812835
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