SARS-CoV-2 Spike Protein in Intestinal Cells of a Patient with Coronavirus Disease 2019 Multisystem Inflammatory...

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Cardiovascular pathology

Background:

• Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of SARS-CoV-2 infection.
• The exact pathophysiology of MIS-C remains incompletely understood, posing challenges for timely diagnosis and treatment.
• Understanding the mechanisms underlying MIS-C is crucial for improving patient outcomes and developing targeted therapies.

Observation:

• A previously healthy 12-year-old boy presented with severe SARS-CoV-2-related MIS-C.
• The patient experienced a rapidly fatal clinical course.
• Autopsy examination identified a significant intracardiac thrombus.

Findings:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein was identified within intestinal cells.
• The presence of viral material in the gut supports the hypothesis linking gut viral reservoirs to the systemic immune response in MIS-C.
• The intracardiac thrombus suggests a potential thrombotic complication contributing to the rapid fatality.

Implications:

• This case highlights the potential for severe thrombotic events in MIS-C.
• The findings suggest that the gastrointestinal tract may serve as a reservoir for SARS-CoV-2, triggering or exacerbating the inflammatory cascade in MIS-C.
• Further research into the gut-immune axis in MIS-C is warranted to explore diagnostic and therapeutic strategies.