Pediatric Multisystemic Inflammatory Syndrome Associated With SARS-CoV-2 Infection

An otherwise healthy 9-year-old boy was brought to us with a 5-day history of abdominal pain and diarrhea, accompanied by fever and a skin rash for the past 2 days. No COVID-19 contact was known, but there had been several cases of febrile respiratory tract infection in his family in the previous few weeks. On admission the patient had confluent exanthema with facial swelling (Figure a) and conjunctivitis, no enanthema, and no lymphadenitis. Laboratory tests revealed leukocytosis (16 800/µL) with left shift (rod neutrophils 26%), lymphocytopenia (2%), eosinophilia (11%); elevated CRP (170 mg/L); elevated D-dimer (1839 ng/mL); and hypalbuminemia (25 g/L). Elevations of CK-MB (30 U/L), troponin (212 ng/L), and NT-proBNP (8565 pg/mL) led to the echocardiographic diagnosis of myocarditis with pericardial effusion; there was no coronary involvement. Sonography revealed ascites and mesenterial lymphadenitis. Serology was negative for cardiotropic viruses and streptococci. PCR was negative for SARS-CoV-2 on two occasions, but the IgG and IgA titers against SARS-CoV-2 were markedly elevated. After initiation of prednisolone treatment, the body temperature swiftly returned to normal with resolution of the vasculitis (Figure b) and myocarditis. Children infected with SARS-CoV-2 may experience a temporally related severe hyperinflammatory syndrome with vasculitic skin lesions—at a time when PCR is negative but serology may already be positive. The pathophysiological context remains to be elucidated.

Figure.

Pediatric multisystemic inflammatory syndrome:

a) Extensive exanthema;

b) improvement after steroid treatment, with residual conjunctivitis

Translated from the original German by David Roseveare.

Cite this as: Schneider DT, Pütz-Dolderer J, Berrang J: Pediatric multisystemic inflammatory syndrome associated with SARS-CoV-2 infection.