Patient 1
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Days 0 |
Onset of fever, asthenia, abdominal pain, and diarrhoea. |
Day 5 |
Hospital admission. Finding of significant increase in acute phase proteins and myocardial injury. Ecocardiography revealed a global reduction in left ventricular ejection fraction (EF 36%) and mild ventricular dysfunction with tricuspid insufficiency. Diagnosis of multisystem inflammatory syndrome in children (MIS-C). Starting treatment with Methylprednisolone, IVIG, Enoxaparine, and Enalapril. |
Day 8 |
Onset of bradycardia. 24-h Holter monitoring showed mean heart rate (HR) 51 with sinus rhythm. |
Day 12 |
Starting treatment with Anakinra. |
Day 14 |
Improvement of HR and systolic function. |
Day 17 |
Cardiac magnetic resonance imaging (MRI) showed sub-acute phase myocarditis, with sub-epicardial involvement of left ventricle. EF 63%. |
Day 28 |
24-h Holter monitoring confirmed the normalization of HR. |
Patient 2
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Day 0 |
Onset of asthenia, laterocervical lymphadenomegaly, fever, and diarrhoea. |
Day 3 |
Hospital admission. Laboratory tests showed significant increase in acute phase proteins and myocardial injury markers. Diagnosis of MIS-C. |
Day 4 |
Starting treatment with Methylprednisolone, IVIG, Enoxaparine, and Enalapril. |
Day 6 |
Ecocardiography revealed thin flap of pericardial effusion (4 mm) with normal cardiac morphology and contractility (EF 62%). |
Day 8 |
Onset of bradycardia. 24-h Holter monitoring showed mean HR 55 with sinus rhythm. |
Day 13 |
Starting treatment with anakinra. |
Day 15 |
Improvement of HR and systolic function. |
Day 27 |
Cardiac MRI showed outcomes of myocarditis with sub-epicardial involvement of the mid-ventricular area. EF 59%. |