COVID-19-Associated Multisystem Inflammatory Syndrome in a Neonate with Atypical Coronary Artery Involvement

Area of Science:

• Pediatric Cardiology
• Neonatalogy
• Infectious Diseases
• Immunology

Background:

• Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication associated with COVID-19.
• Neonatal presentation of MIS-C is uncommon and can involve multiple organ systems.
• Coronary artery abnormalities are a known feature of MIS-C, but atypical presentations can occur.

Purpose of the Study:

• To report a novel case of COVID-19-associated MIS-C in a neonate.
• To highlight the diagnostic challenges in assessing coronary artery involvement in neonatal MIS-C.
• To describe an atypical presentation of coronary artery wall thickening in neonatal MIS-C.

Main Methods:

• Case report of a neonate presenting with multiple organ involvement and coronary artery anomalies.
• Utilized a multi-imaging approach including echocardiography and cardiac computed tomography angiography for coronary artery assessment.
• Diagnosed MIS-C based on maternal SARS-CoV-2 infection, neonatal serological evidence (IgG), and memory B-cell response, excluding other causes.

Main Results:

• The neonate exhibited multiple organ involvement and coronary artery anomalies at birth.
• Echocardiography showed severe coronary artery dilatation, while cardiac CT angiography revealed normal internal diameters.
• Post-discharge analysis identified abnormal diffuse thickening in coronary artery walls as the primary finding, suggesting a non-dilatational vascular remodeling in MIS-C.

Conclusions:

• COVID-19-associated MIS-C can manifest in neonates with significant multi-organ involvement.
• Coronary artery assessment in neonatal MIS-C requires a comprehensive multi-imaging strategy due to potential complexities.
• MIS-C can lead to abnormal thickening of the coronary artery wall, beyond typical lumen dilatation or aneurysms, necessitating careful risk stratification.