Fresh Per Rectal Bleeding in Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)

Abstract

Gastrointestinal manifestations in PIMS-TS are acute abdomen, diarrhea, and malena. However, there are no reports of per rectal bleeding in these children. A 4-mo-old female infant presented with fever, vomiting, lethargy and fresh blood in stool since 1 day. There was no abdominal distension but bowel sounds were sluggish. She was in compensated shock and needed fluid resuscitation, and respiratory and ionotropic support. Her investigations showed neutrophilic leucocytosis, raised inflammatory and cardiac markers, and sterile blood culture. Coronavirus disease 2019 (COVID-19) immunoglobulin G (IgG) antibodies were positive 6.26 S/CO (< 1.4) and reverse transcription polymerase chain reaction (RT-PCR) was negative. The father was COVID-19 RT-PCR positive one month back. She had 3 episodes of fresh blood in stool; hemoglobin dropped to 8 g/dL; needed transfusion. Echocardiography showed dilated both coronaries with high z score > 2.5 Computed tomography showed dilated jejunum and proximal ileum suggestive of obstruction. Exploratory laparotomy showed extensively congested ileum and tiny fibrous band about 2.5 cm crossing from antimesenteric border to mesentery in proximal ileum. No obvious volvulus was seen. This tiny band cannot cause ischemic changes unless accompanied by volvulus. She was treated with piperacillin-tazobactam, amikacin, immunoglobulin, and methylprednisolone following which inflammatory markers decreased and she was subsequently discharged. On follow-up, she had good weight gain and normal coronaries.

Unique Complications of MIS-C and Its Treatment: Encephalopathy in a Child with MIS-C Who Developed Life-Threatening Gastrointestinal Hemorrhage

“…We report the case of a child diagnosed with MIS-C who initially presented with shock and encephalopathy followed by a second admission with severe upper GI hemorrhage. The patient's brain magnetic resonance imaging (MRI) demonstrated inflammation of the corpus callosum, an imaging finding similar in nature to those in recent reports of fifteen children with COVID-19 and/or MIS-C and neurologic dysfunction [3][4][5][6][7]. We hypothesize that the vasculitic nature of MIS-C combined with anti-inflammatory treatment caused severe GI bleeding.…”

“…Fortunately, these lesions and associated clinical symptoms are typically reversible [13]. A clinical-radiologic syndrome known as cytotoxic lesion(s) of the corpus callosum, radiographically characterized by variable-sized lesions predominantly located in the splenium, has been reported in twenty children diagnosed with COVID-19 and/or MIS-C, supporting potential mechanistic link to the diseases [3][4][5][6][7][8]. [1].…”

Multisystem Inflammatory Syndrome in Neonates Born to Mothers with SARS-CoV-2 Infection (MIS-N) and in Neonates and Infants Younger Than 6 Months with Acquired COVID-19 (MIS-C): A Systematic Review

“…N.A. Kappanyil [25] Case report India 6 Good Khaund Borkotoky [26] Case report India 5 Intermediate Jones [27] Case report United States 5 Intermediate Lad [28] Case report India 2 Low Lima [29] Case report Brazil 6 Good Lorenz [30] Case report Germany 3 Intermediate Luna Santiago [31] Case report Mexico 3 Intermediate Malle [41] Case series United States 6 Good Mariani [32] Case report United States 3 Intermediate Marino [42] Case series Italy 4 Intermediate McCarty [33] Case report United States 5 Intermediate Mehra [57] Cohort study India N.A. N.A.…”

“…Twenty-five included papers [13,[16][17][18][21][22][23][24]27,28,31,32,[34][35][36][37][40][41][42][43][44][45]47,52,53] describe 32 neonates and infants under the age of six months with multisystem inflammatory syndrome after the acquired SARS-CoV-2 infection (Table 3). Only six (18,8%) of these infants, had comorbidities.…”

Tube Feeding-Related Bowel Ischemia Presenting As Extensive Intestinal Pneumatosis Complicated With Hepatic Portal Venous Gas

“…Treatment for HPVG should be based on the underlying cause of disease and involves conservative or surgical management [5]. Surgery is indicated in portal-mesenteric vein gas and the presence of bowel ischemia [11]. Stopping tube feeding is paramount, and early parenteral nutrition should be considered.…”