Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children.

ABSTRACT: BACKGROUND:A recent increase in children admitted with hypotensive shock and fever in the context of the COVID-19 outbreak requires an urgent characterization and assessment of the involvement of SARS-CoV-2 infection. This is a case series performed at 4 academic tertiary care centers in Paris of all the children admitted to the pediatric intensive care unit (PICU) with shock, fever and suspected SARS-CoV-2 infection between April 15th and April 27th, 2020. RESULTS:20 critically ill children admitted for shock had an acute myocarditis (left ventricular ejection fraction, 35% (25-55); troponin, 269 ng/mL (31-4607)), and arterial hypotension with mainly vasoplegic clinical presentation. The first symptoms before PICU admission were intense abdominal pain and fever for 6 days (1-10). All children had highly elevated C-reactive protein (>?94 mg/L) and procalcitonin (>?1.6 ng/mL) without microbial cause. At least one feature of Kawasaki disease was found in all children (fever, n?=?20, skin rash, n?=?10; conjunctivitis, n?=?6; cheilitis, n?=?5; adenitis, n?=?2), but none had the typical form. SARS-CoV-2 PCR and serology were positive for 10 and 15 children, respectively. One child had both negative SARS-CoV-2 PCR and serology, but had a typical SARS-CoV-2 chest tomography scan. All children but one needed an inotropic/vasoactive drug support (epinephrine, n?=?12; milrinone, n?=?10; dobutamine, n?=?6, norepinephrine, n?=?4) and 8 were intubated. All children received intravenous immunoglobulin (2 g per kilogram) with adjuvant corticosteroids (n?=?2), IL 1 receptor antagonist (n?=?1) or a monoclonal antibody against IL-6 receptor (n?=?1). All children survived and were afebrile with a full left ventricular function recovery at PICU discharge. CONCLUSIONS:Acute myocarditis with intense systemic inflammation and atypical Kawasaki disease is an emerging severe pediatric disease following SARS-CoV-2 infection. Early recognition of this disease is needed and referral to an expert center is recommended. A delayed and inappropriate host immunological response is suspected. While underlying mechanisms remain unclear, further investigations are required to target an optimal treatment.

SUBMITTER: Grimaud M 

PROVIDER: S-EPMC7266128 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature