Neonatal MIS-C: Managing the Cytokine Storm

• DOI: 10.1542/peds.2020-042093
• Publication Date: 2021-08-25T08:30:14Z
• Authors: Sumita Saha; Priyankar Pal; Devdeep Mukherjee
• Keywords: Prednisolone; Oliguria; Pulmonary hemorrhage

A term infant girl with uneventful antenatal history had an erythematous rash followed by fever from day 8. She was diagnosed late-onset sepsis and treated accordingly. received immunoglobulin for persistent thrombocytopenia, after which there transient improvement. The patient transferred to our hospital on 25 recurrence of fever, watery diarrhea, a generalized maculopapular rash. On admission, she tachycardia, tachypnoea, anemia, hypoalbuminemia, edema. Reverse transcriptase-polymerase chain reaction results coronavirus disease 2019 (COVID-19) positive. Within 12 hours developed cardiogenic shock pulmonary edema needed invasive ventilation. Echocardiography revealed ejection fraction 40% mild pericardial effusion. N-terminal pro-brain natriuretic peptide 33000 g/L, D-dimer 16500 µg/L, ferritin 16000 ng/mL. Methylprednisolone, immunoglobulin, enoxaparin started, diagnosis multisystem inflammatory syndrome in children, associated COVID-19. seizures, hemorrhage, cardiac arrest the following day, along acute kidney injury. extubated 5 days. Steroid stopped days because hypertension echocardiography normalized. Five extubation, again respiratory distress ventilated 2 moderate left ventricular dysfunction, secondary elevation ferritin. Methylprednisolone restarted continued tapering dose oral prednisolone, finally discharged. Although myocarditis COVID-19 has been reported, children newborn refractory myocarditis, gastrointestinal renal manifestations, is rare entity. Dermatologic manifestation neonatal also unique.