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 Pa...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-06-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00690-8 |
| _version_ | 1811328540646309888 |
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| author | Marion Grimaud Julie Starck Michael Levy Clémence Marais Judith Chareyre Diala Khraiche Marianne Leruez-Ville Pierre Quartier Pierre Louis Léger Guillaume Geslain Nada Semaan Florence Moulin Matthieu Bendavid Sandrine Jean Géraldine Poncelet Sylvain Renolleau Mehdi Oualha |
| author_facet | Marion Grimaud Julie Starck Michael Levy Clémence Marais Judith Chareyre Diala Khraiche Marianne Leruez-Ville Pierre Quartier Pierre Louis Léger Guillaume Geslain Nada Semaan Florence Moulin Matthieu Bendavid Sandrine Jean Géraldine Poncelet Sylvain Renolleau Mehdi Oualha |
| author_sort | Marion Grimaud |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T15:28:01Z |
| format | Article |
| id | doaj.art-961feb27102d462ca2a33468a024dbfb |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-13T15:28:01Z |
| publishDate | 2020-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-961feb27102d462ca2a33468a024dbfb2022-12-22T02:41:28ZengSpringerOpenAnnals of Intensive Care2110-58202020-06-011011510.1186/s13613-020-00690-8Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill childrenMarion Grimaud0Julie Starck1Michael Levy2Clémence Marais3Judith Chareyre4Diala Khraiche5Marianne Leruez-Ville6Pierre Quartier7Pierre Louis Léger8Guillaume Geslain9Nada Semaan10Florence Moulin11Matthieu Bendavid12Sandrine Jean13Géraldine Poncelet14Sylvain Renolleau15Mehdi Oualha16Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de ParisPediatric and Neonatal Intensive Care Unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de ParisPediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de ParisPediatric and Neonatal Intensive Care Unit, Kremlin-Bicêtre University Hospital, Assistance Publique-Hôpitaux de ParisPediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de ParisM3C-Necker, Congenital and Pediatric Cardiology, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de ParisLaboratoire de Virologie, Paris UniversityPaediatric Hematology-Immunology and Rheumatology Unit, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, IMAGINE Institute, Université de ParisPediatric and Neonatal Intensive Care unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne UniversityPediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de ParisPediatric and Neonatal Intensive Care Unit, Kremlin-Bicêtre University Hospital, Assistance Publique-Hôpitaux de ParisPediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de ParisPediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de ParisPediatric and Neonatal Intensive Care Unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de ParisPediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de ParisPediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris UniversityPediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris UniversityAbstract 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.http://link.springer.com/article/10.1186/s13613-020-00690-8ShockChildrenAcute myocarditisMultisystem inflammatory syndromeSARS-CoV-2 |
| spellingShingle | Marion Grimaud Julie Starck Michael Levy Clémence Marais Judith Chareyre Diala Khraiche Marianne Leruez-Ville Pierre Quartier Pierre Louis Léger Guillaume Geslain Nada Semaan Florence Moulin Matthieu Bendavid Sandrine Jean Géraldine Poncelet Sylvain Renolleau Mehdi Oualha Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children Annals of Intensive Care Shock Children Acute myocarditis Multisystem inflammatory syndrome SARS-CoV-2 |
| title | Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children |
| title_full | Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children |
| title_fullStr | Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children |
| title_full_unstemmed | Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children |
| title_short | Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children |
| title_sort | acute myocarditis and multisystem inflammatory emerging disease following sars cov 2 infection in critically ill children |
| topic | Shock Children Acute myocarditis Multisystem inflammatory syndrome SARS-CoV-2 |
| url | http://link.springer.com/article/10.1186/s13613-020-00690-8 |
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