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A Case of COVID-19-Associated Pediatric Multisystem Inflammatory Syndrome in Shock Managed by Cytokine Filtration
Priyanka Lalwani1,2, Subashini Baskaran1,2, Diego Arango Uribe1
1Pediatric Intensive Care Unit, Al Jalila Children's Specialty Hospital, Dubai, UAE.
Insights
This case report details the successful use of a cytokine filter in a child with severe Multisystem Inflammatory Syndrome in Children (MIS-C) following COVID-19. The cytokine filter, used with continuous renal replacement therapy, rapidly improved the patient
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of COVID-19, often involving a cytokine storm.
- Current management strategies for MIS-C include intravenous immunoglobulin and immunomodulators.
- Cytokine filters are known to reduce cytokine levels and vasopressor dependence in other inflammatory conditions.
Observation:
- A 7-year-old child presented with prolonged fever, vomiting, hypotension, and coronary artery dilatation.
- The child tested positive for SARS-CoV-2 and was diagnosed with MIS-C.
- Management involved mechanical ventilation, vasopressors, and continuous renal replacement therapy (CRRT).
Findings:
- CRRT was initiated with a cytokine filter (oXiris®).
- The patient showed significant clinical improvement within 24 hours of CRRT initiation.
- This is the first reported case of oXiris® use in MIS-C.
Implications:
- Cytokine filters may be a valuable tool for managing severe MIS-C cases.
- Further research, including case series and controlled trials, is needed to confirm efficacy.
- This approach could potentially reduce the need for vasopressors and improve outcomes in pediatric critical care.
Abstract:
Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 has been recognized as a complication arising due to cytokine storm. Several management strategies including intravenous immunoglobulin and immunomodulators have been reported. This case report highlights the use of a cytokine filter (oXiris®) in the management of MIS-C. Cytokine filters eliminate cytokines and reduce the demand for vasopressors in patients with other inflammatory conditions. A 7-year-old child with prolonged fever, vomiting, hypotension, elevated inflammatory mediators, and dilatation of coronary arteries on echocardiography was found to have positive SARS-CoV-2 IgG and PCR. He was diagnosed as MIS-C and was managed in the pediatric intensive care unit. He required ventilatory support, vasopressors, and continuous renal replacement therapy (CRRT) with a cytokine filter. He showed marked improvement within 24 hours of initiating CRRT. Cytokine filters may have a potential role in the management of severely ill children due to MIS-C. To our knowledge, this is the first report of successful use of the oXiris® membrane in MIS-C. However, further case series and controlled trials are needed to establish its use in this condition.
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