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A fatal toxic shock-like syndrome post COVID-19 infection in a child

Houda Ajmi1, Wissem Besghaier2, Wafa Kallala3

  • 1Department of Pediatrics, Sahloul University Hospital, 4054, Sousse, Tunisia. hd.ajmi@gmail.com.

Italian Journal of Pediatrics
|June 3, 2021
PubMed

Insights

A severe COVID-19 complication, multi-system inflammatory syndrome (MIS-C), can cause fatal shock in children. This pediatric case highlights refractory vasoplegia as a cause of hypotension in MIS-C.

Area of Science:

  • Pediatric critical care medicine
  • Infectious diseases
  • Cardiology

Background:

  • Coronavirus disease 2019 (COVID-19) presents with diverse manifestations in children.
  • Severe cases can develop into multi-system inflammatory syndrome (MIS-C), leading to multiple organ dysfunction.

Observation:

  • A 12-year-old girl with recent COVID-19 developed MIS-C symptoms, including fever and abdominal pain.
  • She experienced rapid deterioration with refractory shock and multiple organ failure despite intensive care and treatment.
  • Echocardiography revealed a small pericardial effusion but normal ejection fraction and no coronary or valvular lesions.

Findings:

  • The patient presented with lymphopenia and elevated inflammatory markers.
  • Treatment with intravenous immunoglobulin, fresh frozen plasma, vasopressors, and corticosteroids was ineffective.
  • The case was fatal, underscoring the severity of this COVID-19 related condition.

Implications:

  • COVID-19-related MIS-C can mimic Kawasaki disease shock syndrome, presenting life-threatening conditions in pediatric patients.
  • Hypotension in MIS-C may stem from heart failure, decreased cardiac output, or refractory vasoplegia.
  • This case highlights a severe clinical manifestation of SARS-CoV-2 infection in children, emphasizing the need for prompt recognition and management.
Abstract

Keywords:
ChildCoronavirus infectionMulti-system inflammatory syndromeTSS: toxic shock syndromeToxic shock syndrome

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