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#Grand Rounds

Hyperinflammatory Shock in Children and COVID-19

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BACKGROUND AND PURPOSE:

  • Riphagen et al. (The Lancet, 2020) provide one of the initial reports of  a cluster of hyperinflammatory shock cases in children, linked to COVID-19 and now known as Pediatric Multi-System Inflammatory Syndrome

METHODS:

  • Setting
    • South Thames Retrieval Service in London, UK
  • Patients
    • 8 children with hyperinflammatory shock (similar to atypical Kawasaki disease, Kawasaki disease shock syndrome, or toxic shock syndrome)
    • Previously well
    • Demographic info
      • 6 children were of Afro-Caribbean descent
      • 5 males | 3 females
      • 7 were well above 75th centile for weight
      • 4 had known exposure to SARS-CoV-2

RESULTS:

  • Clinical presentation
    • Persistent fever (38–40°C)
    • Variable rash
    • Conjunctivitis
    • Peripheral edema
    • Generalized extremity pain
    • Significant GI symptoms
    • Most did not have significant respiratory involvement
  • Laboratory evidence of infection/inflammation
    • Increased levels of CRP, procalcitonin, ferritin, triglycerides, and D-dimers
  • SARS-CoV-2 testing
    • All patients negative for virus
    • Pathogen only identified in 1 child (adenovirus and enterovirus)
  • Echocardiographic finding
    • Echo-bright coronary vessels were a common finding
    • One patient developed a giant coronary aneurysm within a week of discharge from pediatric intensive care (PICU)
      • Patient died following a right MCA and ACA ischemic infarction
  • Treatment
    • All children received
      • IVIG (2 g/kg) in the first 24 hours and ceftriaxone and clindamycin
      • Six children were given 50 mg/kg aspirin
  • Outcomes
    • Children discharged from PICU after days 4 to 6
    • 2 children subsequently tested positive for SARS-CoV-2
    • All children continue to be monitored for coronary abnormalities

CONCLUSION:

  • In a follow up since submission of the manuscript
    • All 8 children were antibody positive for SARS-CoV-2
    • The hospital has treated >20 children with a similar clinical presentation
    • Multiple other centers have identified a similar constellation of findings that has now been named the Pediatric Multi-System Inflammatory Syndrome (see ‘Related ObG Topics’ for a review) 

Learn More – Primary Sources:

Hyperinflammatory shock in children during COVID-19 pandemic

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