MULTISYSTEM-INFLAMMATORY SYNDROME (MIS-C) IN NEONATE ASSOCIATED WITH SARS-COVID19

Abstract

Background: Multisystem-Inflammatory Syndrome in Children (MIS-C) is a rare complication of COVID-19 infection in the pediatric population which greatly enhances the risk for thrombotic complications including disseminated intravascular coagulation (DIC). Furthermore, treating complications of DIC is complex as treating one complication can exacerbate the other, and the underlying COVID-19 infection and MIS-C as a whole. This makes choosing the most appropriate treatment difficult.Aim: To report on case of MIS-C in neonate who developed DIC with multiple thrombotic and hemorrhagic events.Methods: In our study, we analyzed a clinical case of a neonate diagnosed with MIS-C who developed DIC with damage to the heart, kidneys, lungs, liver and adrenal glands.Results: After infection with SARS-CoV2, MIS-C developed which led to systemic inflammation that triggered DIC, as proven by laboratory markers. DIC led to thrombotic and hemorrhagic events that affected multiple organs, which led to the following: Pre-renal Acute Kidney Injury-renal failure, acute adrenal insufficiency (Waterhouse-Friderichsen syndrome), ileofemoral thrombosis, right atrial thrombosis, Left ventricle thrombosis and fixed aortic thrombosis. Furthermore, the treatment of MIS-C and that of the complications of DIC were contraindicated on several occasions.Conclusion: This case demonstrated that MIS-C and DIC modulated each other which worsened the prognosis for this neonate initially. With many critical comorbidities the treatment for this case became complex, treating one complication would exacerbate the other, especially noted when the neonate suffered adrenal hemorrhage. Although prognosis was poor, the neonate recovered due to precise control of treatment tactics by the multidisciplinary team.