Delayed Coronary Dilation with Multisystem Inflammatory Syndrome in Children

Nelson, Meghan Corrigan; Mrosak, Justine; Hashemi, Sassan; Manos, Cynthia K; Prahalad, Sampath; Varghese, Susan; Oster, Matthew E.

doi:10.1016/j.case.2021.08.002

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…Coronary aneurysmal progression despite current standard therapy has recently been reported. 22 Nelson et al has reported upon three patients who developed either primary or worsening dilation after initial treatment with IVIG. Two out of the three patients in their case series received infliximab for progression of coronary involvement, with either stabilisation or improvement on short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement

et al. 2022

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Objectives: We aim to describe the early and upto 16 months follow-up of post-coronavirus disease (COVID), multi-system inflammatory syndrome in children (MIS-C), with special reference to cardiac involvement. Study design: This cohort non-interventional descriptive study included patients <18 years admitted between May, 2020 and April, 2021. Based on underlying similarities, children were classified as post-COVID MIS-C with overlapping Kawasaki Disease, MIS-C with no overlapping Kawasaki Disease, and MIS-C with shock. Post-discharge, patients were followed at 1, 3, 6, 12, and 16 months. Results: Forty-one patients predominantly males (73%), at median age of 7 years (range 0.2–16 years) fulfilled the World Health Organisation criteria for MIS-C. Cardiac involvement was seen in 15 (36.5%); impaired left ventricle (LV) function in 5 (12.2%), coronary artery involvement in 10 (24.4%), pericardial effusion in 6 (14.6%) patients, and no arrhythmias. There were two hospital deaths (4.9%), both in MIS-C shock subgroup (2/10, 20%). At 1 month, there was persistent LV dysfunction in 2/5, coronary artery abnormalities in 7/10, and pericardial effusion resolved completely in all patients. By 6 months, LV function returned to normal in all but coronary abnormalities persisted in two patients. At last follow-up (median 9.8 months, interquartile range 2–16 months), in 36/38 (94.7%) patients, coronary artery dilatation was persistent in 2 (20%) patients. Conclusions: Children with MIS-C have a good early outcome, though MIS-C with shock can be life-threatening subgroup in a resource-constrained country setting. On midterm follow-up, there is normalisation of LV function in all and recovery of coronary abnormalities in 80% of patients.

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Section: Discussionmentioning

confidence: 99%

Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement

et al. 2022

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“…MIS-C has been associated with cardiac manifestations in >80% of cases, but reports of giant coronary aneurysms (z-score ≥ 10 or diameter ≥ 8 mm) and delayed coronary dilation in MIS-C are scarce. 3–5 In our patient, coronary aneurysms developed after the administration of IVIG, and much later in his disease course—nearly 3 weeks after he was initially symptomatic. Infliximab has been shown to improve coronary aneurysms in refractory MIS-C and in other types of vasculitis including KD and Behçet Disease.…”

Section: Discussionmentioning

confidence: 55%

“…1,2 Cardiac manifestations are common during the acute MIS-C episode, but delayed giant coronary aneurysms and readmissions are rare. 3–6 MIS-C with onset after COVID-19 vaccination has been described, with most cases having had evidence of prior SARS-CoV-2 infection. 7–12…”

mentioning

confidence: 99%

Multiple MIS-C Readmissions and Giant Coronary Aneurysm After COVID-19 Illness and Vaccination: A Case Report

Haq

Anyalechi

Schlaudecker

et al. 2022

Pediatric Infectious Disease Journal

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Background: Multisystem inflammatory syndrome in children (MIS-C) rarely involves delayed giant coronary aneurysms, multiple readmissions or occurrence after COVID-19 vaccination. Methods: We describe a child with all 3 of these unusual features. We discuss his clinical presentation, medical management, review of the current literature and CDC guidance recommendations regarding further vaccinations. Results: A 5-year-old boy had onset of MIS-C symptoms 55 days after COVID-19 illness and 15 days after receiving his first BNT162b2 COVID-19 vaccination. He was admitted 3 times for MIS-C, and twice after his steroid dose was tapered. On his initial admission, he was given intravenous immunoglobulin and steroids. During his second admission, new, moderate coronary dilation was noted, and he was treated with intravenous immunoglobulin and steroids. At his last admission, worsening coronary dilation was noted, and he was treated with infliximab and steroids. During follow-up, he had improvement in his coronary artery dilatation. However, his inflammatory markers increased after steroid wean, and his steroid taper was further extended, after which time his inflammatory markers improved. This is the only such reported case of a patient who was admitted 3 times for MIS-C complications after COVID-19 vaccination. Conclusion: MIS-C rarely involves delayed giant coronary aneurysms, multiple readmissions, or occurrence after COVID-19 vaccination. Whether our patient’s COVID-19 vaccine 6 weeks after COVID-19 illness contributed to his MIS-C is unknown. After consultation with the CDC-funded Clinical Immunization Safety Assessment Project, the patient’s care team decided against further COVID-19 vaccination until at least 3 months post normalization of inflammatory markers.

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“…Coronary artery aneurysm progression after IVIG seen in this patient and others underlines the importance of learning more about the difference in pathophysiology between KD and MIS-C so that potentially better directed therapies can be developed. 2 Her case also raises the question of whether closer outpatient follow up or earlier treatment could have prevented such significant aneurysms or affected the probability of regression.…”

Section: Case Presentationmentioning

confidence: 99%

“…Based on similarities in patient presentations, MIS-C treatment has been largely dictated by standard KD treatment, including aspirin, IVIG, and glucocorticoids. However, limited reports have described a subset of MIS-C patients who experienced development or further progression of coronary aneurysms despite receiving current standard therapy [4],…”

Section: Introductionmentioning

confidence: 99%

Giant coronary aneurysms in an infant: Dilemma of MIS‐C

et al. 2022

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COVID-19 related MIS-C (Multisystem in ammatory syndrome in children) can present with cardiovascular complications like shock, arrhythmias, pericardial effusion, and coronary artery dilatation. The majority of MIS-C associated coronary artery abnormalities are dilation or small aneurysms which are transient and resolve in a few weeks [1,2]. We present here a case of a 3-month-old child who was noted to have giant aneurysms of her coronary arteries (LAD and RCA) twenty-six days after testing positive for COVID-19. She was treated with IVIG, in iximab, and glucocorticoids along with aspirin, clopidogrel and enoxaparin. She did not show any signs of coronary ischemia or cardiac dysfunction but continued to have persistent giant coronary artery aneurysms involving the LAD (z-score ~35) and RCA (z-score ~30) [Fig. 1]. This study emphasizes the importance of early detection and aggressive management of MIS-C to prevent potentially life-threatening consequences.

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Delayed Coronary Dilation with Multisystem Inflammatory Syndrome in Children

Cited by 9 publications

References 13 publications

Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement

Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement

Multiple MIS-C Readmissions and Giant Coronary Aneurysm After COVID-19 Illness and Vaccination: A Case Report

Giant coronary aneurysms in an infant: Dilemma of MIS‐C

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