Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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A Case of Multisystem Inflammatory Syndrome in Children (MIS-C) with Acute Myocarditis

  • Lim, Jin Gyu (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Lee, Da Hye (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Oh, Kyung Jin (Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Choi, Sujin (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Song, Young Hwan (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Lee, Joowon (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Lee, Hyunju (Department of Pediatrics, Seoul National University Bundang Hospital)
  • Received : 2021.09.06
  • Accepted : 2021.10.25
  • Published : 2021.12.25
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Abstract

After initial reports of multisystem inflammatory syndrome in children (MIS-C) in April 2020 in Europe, this disease has been known to occur in children with recent history of coronavirus disease 2019 (COVID-19) and most cases have been reported in Europe and the Unites States of America. We report a case of a 14-year-old girl who was diagnosed with MIS-C with acute myocarditis and successfully treated with intravenous immunoglobulin (IVIG), methylprednisolone, and anakinra. At initial presentation, she had persistent high fever, generalized rash, generalized swelling, abdominal pain, and low blood pressure. She showed a remarkably elevated level of inflammation and cardiac enzyme markers and had a previous history of COVID-19 5 weeks before the initial presentation. After extensive work up, other infectious and non-infectious causes were excluded. She was diagnosed with MIS-C and initially treated with IVIG and high-dose methylprednisolone; however, despite treatment, her heart function deteriorated and coronary artery dilatation progressed. Therefore, anakinra, an interleukin-1 receptor antagonist, was administered on hospital day 6, after which her cardiac function exhibited improvement. She was discharged on hospital day 19 without any symptoms, and follow-up echocardiography after 1 month revealed fully recovered heart function with normal coronary arteries.

2020년 4월에 유럽에서 처음으로 소아 다기관 염증 증후군(multisystem inflammatory syndrome in children; MIS-C)이 확인된 이후, MIS-C는 코로나바이러스감염증-19(COVID-19)의 병력이 있는 소아들에게서 발병하는 것으로 알려졌고 대부분의 환자들은 유럽과 미국에서 보고되었다. 이에 국내에서 진단된 MIS-C 사례로, 급성 심근염이 동반되고 정맥내 면역글로불린(intravenous immunoglobulin; IVIG), 스테로이드 및 anakinra로 효과적으로 치료한 증례를 보고하고자 한다. 내원 5주 전 COVID-19 진단받은 병력이 있는 14세 여아가 지속되는 고열, 전신 발진 및 부종, 복통, 그리고 저혈압을 주소로 내원하였다. 혈액검사에서 염증수치 및 심장효소수치 상승을 보였고 감염질환을 비롯하여 다른 질환이 배제되었다. 환자는 MIS-C 진단 하에 IVIG와 고용량 메틸프레드니솔론(methylprednisolone) 요법으로 치료하였으나 심기능이 점차 악화되고 관상동맥 확장증이 확인되었다. 이에 제6병일부터 인터루킨-1 수용체 길항제인 anakinra를 투여하였고 이후 점차 환자의 심기능이 호전되었다. 환자는 제19병일에 퇴원하였고 1개월 후 시행한 심초음파상 심기능 및 관상동맥이 정상화되었다.

Keywords

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