Case Report: Successful Treatment of a Child With COVID-19 Reinfection-Induced Fulminant Myocarditis by Cytokine-Adsorbing oXiris® Hemofilter Continuous Veno-Venous Hemofiltration and Extracorporeal Membrane Oxygenation

Abstract

BackgroundIndirect cardiomyocyte damage-related hyperinflammatory response is one of the key mechanisms in COVID-19-induced fulminant myocarditis. In addition to the clinical benefit of using cytokines absorption hemofiltration, the effectiveness of instituting veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiac compromise has been reported. However, current literature enunciates a paucity of available data on the effectiveness of these novel modalities.Case PresentationWe reported a 9-year-old boy with recurrent COVID-19 infection-causing fulminant myocarditis, who was treated successfully by using novel modalities of oXiris® hemofilter continuous venovenous hemofiltration (CVVH) and VA-ECMO. The patient made a full recovery without any sequelae.ConclusionWe conclude that the novel highly-absorptive hemofilter CVVH and VA-ECMO may be effective treatment modalities in managing SARS-CoV-2-induced fulminant myocarditis. Our report highlights the need for further well-designed investigations to confirm this extrapolation.

Blood Purification with oXiris© in Critically Ill Children with Vasoplegic Shock

“…This study is the first to report on the use of oXiris© in children with vasoplegic shock. Phan et al [17] reported on a 9-year-old child treated with a combination of VA-ECMO and oXiris© for fulminant myocarditis related to COVID-19. Pediatric patients treated with other devices for blood purification or with conventional CRRT are largely reported.…”

“…The reduction of thrombocyte count was not constantly described in the literature. Schwidenhammer et al [15] did not report a thrombocyte count reduction, while others reported a significant decrease over time [17, 20, 27]. However, the real clinical impact of such reduction is unknown in the absence of bleeding.…”

Case report: VA-ECMO for fulminant myocarditis in an infant with acute COVID-19

“…Infection with viral pathogens, such as influenza and parvovirus B-19, has been widely described as the most common etiology of acute myocarditis, but less is known about cardiac complications of SARS-CoV-2 infection. While myocardial problems associated with SARS-CoV-2 have been well reported in adults, few cases of pediatric COVID-19-related acute myocarditis have been reported to date (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). We collected twelve such case reports, as shown in Table 2.…”

“…IVIGs are commonly used to treat inflammatory diseases with cardiac involvement due to their immune-modulating activity. CVVH may limit further cardiotoxicity from possible indirect damage in fulminant hypercytokinemia-associated SARS-CoV-2 ( 15 ). Remdesivir, a direct-acting nucleotide prodrug inhibitor of the SARS-CoV-2 RNA-dependent RNA polymerase, may shorten the recovery time in patients hospitalized with COVID-19 and was associated with fewer days of subsequent oxygen use in patients receiving oxygen and shorter subsequent duration of mechanical ventilation or ECMO ( 21 ).…”

“…As the variants of SARS-CoV-2 subsequently appeared with variable clinical and epidemiological traits, COVID-19 has been spreading rapidly in Taiwan since April, 2022. Although acute SARS-CoV-2 infection is often asymptomatic or mild in children (1), some cases of severe infection within the pediatric population have been documented, including acute respiratory distress syndrome (ARDS) (2), encephalitis (3), and acute myocarditis (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), but lifethreatening complications, such as fulminant myocarditis, are rare. Here, we report a case of acute COVID-19 complicated with fulminant myocarditis in a 9-month-old infant.…”