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

Abstract

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.

Epidemiological and clinical evolution of multisystem inflammatory syndrome in children throughout the SARS‐CoV‐2 pandemic in a tertiary Italian children's hospital

“…Our data show a significant decrease in the groups of vaccinated children comparing the pre and post‐vaccination periods, suggesting a protective role of the vaccine. Despite the reports of post‐vaccination MIS‐C, 14,15 literature data seem to support that vaccination lowers the overall MIS‐C burden, probably by preventing infection 16,17 . High effectiveness (91–94%) of two doses of Pfizer–BioNTech vaccines against MIS‐C during the Delta wave was found, primarily explained by the increased effectiveness against the Delta variant 16,17 .…”

Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review

“…Blood tests showed an increase in cardiac markers (troponin and pro-BNP) without any anomalies on the ECG or echocardiogram in two reported cases [110,112]. Three patients developed coronary dilation [104,111,112]. Cardiac failure with LVSD was documented in three cases [102,106,108].…”

“…Neurologic manifestations were reported in one case [108]. For all patients, the first-line treatment consisted of IVIG, associated with systemic corticosteroids in almost all cases (92%) [101,[104][105][106][107][108][109][110][111]. Two patients required biologic treatment with infliximab and anakinra, respectively [106,111].…”

“…For all patients, the first-line treatment consisted of IVIG, associated with systemic corticosteroids in almost all cases (92%) [101,[104][105][106][107][108][109][110][111]. Two patients required biologic treatment with infliximab and anakinra, respectively [106,111]. Four patients received ASA as antiaggregant therapy for the increased risk of thrombotic events [101,[110][111][112].…”

How the COVID-19 Pandemic Contributed to Diagnostic Bias

“…Coronary artery fistula is a rare congenital or acquired condition that involves abnormal communication between a coronary artery and either a cardiac chamber (coronary-cameral fistula) or any segment of the systemic or pulmonary circulations (coronary-arteriovenous fistula) [ 1 ]. Moreover, coronary dilatation can be a shared feature of other disorders, notably Kawasaki disease and the Kawasaki-like coronavirus disease 2019 (COVID-19)-induced multi-inflammatory syndrome of children (MIS-C) [ 2 , 3 ].…”