Acute Myocardial Infarction in a 9-Year-Old Boy Due to Multisystem Inflammatory Syndrome

Multisystem Inflammatory Syndrome Versus Kawasaki Disease: Potential Differences in Pathogenetic and Clinical Implications

“…Multisystem inflammatory syndrome in children (MIS-C) has been suggested as a SARS-CoV-2-related proinflammatory condition that has a strong analogy to Kawasaki disease (KD), particularly in terms of its clinical findings. 1 , 2 The recently published report by Duman et al 1 has described an interesting case of acute myocardial infarction associated with MIS-C in a 9-year-old boy. In this regard, we would like to have further information on this interesting case and also make a few comments on potential differences between MIS-C and KD in the clinical setting:…”

“… 2 In this context, we wonder about the exact temporal and clinical details of SARS-CoV-2 exposure in the patient. 1 Was it just an asymptomatic exposure or an overt infection?…”

“…Second, both conditions present with persistent high-grade fever and involvement of various organ systems including cardiovascular (myocardium and coronary arteries) and gastrointestinal system along with mucosal and dermatological findings. 1 - 4 , 6 Importantly, serious myocardial involvement and the need for inotropic support (and admission to intensive care unit) might be more prevalent in the setting of MIS-C compared with KD. 2 We hold the opinion that the patient, 1 together with his coronary involvement, also had a “myocarditis component” (as consistent with left ventricular (LV) global hypokinesia and substantial troponin elevation).…”

“… 1 - 4 , 6 Importantly, serious myocardial involvement and the need for inotropic support (and admission to intensive care unit) might be more prevalent in the setting of MIS-C compared with KD. 2 We hold the opinion that the patient, 1 together with his coronary involvement, also had a “myocarditis component” (as consistent with left ventricular (LV) global hypokinesia and substantial troponin elevation). On the other hand, myocarditis in this context has been largely ascribed to “reversible myocardial stunning” associated with cytokine storm (rather than true myonecrosis).…”

“…On the other hand, myocarditis in this context has been largely ascribed to “reversible myocardial stunning” associated with cytokine storm (rather than true myonecrosis). 2 Therefore, we wonder whether the LV systolic functions of the patient 1 improved on follow-up.…”