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Multiple MIS-C Readmissions and Giant Coronary Aneurysm After COVID-19 Illness and Vaccination: A Case Report

Khadija Haq1,2, E Gloria Anyalechi3, Elizabeth P Schlaudecker4

  • 1From the Children's Healthcare of Atlanta.

The Pediatric Infectious Disease Journal
|February 2, 2023
PubMed

Insights

Multisystem inflammatory syndrome in children (MIS-C) can rarely present with giant coronary aneurysms and multiple hospitalizations after COVID-19 vaccination. This case highlights a unique presentation of MIS-C with these rare features.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition.
  • Giant coronary aneurysms and multiple readmissions are infrequent complications of MIS-C.
  • The occurrence of MIS-C after COVID-19 vaccination is uncommon.

Observation:

  • A 5-year-old boy developed MIS-C 55 days after COVID-19 infection and 15 days after his first BNT162b2 vaccine dose.
  • The child experienced three hospital admissions for MIS-C, with two occurring after steroid dose tapering.
  • Coronary artery dilation, initially moderate and later worsening, was observed during admissions and required treatment with IVIG, steroids, and infliximab.

Findings:

  • This case represents the first reported instance of a child admitted three times for MIS-C complications following COVID-19 vaccination.
  • The patient showed improvement in coronary artery dilation but experienced increased inflammatory markers upon steroid wean, necessitating an extended steroid taper.
  • The potential contribution of the COVID-19 vaccine to the MIS-C onset, occurring 6 weeks after infection, remains undetermined.

Implications:

  • This case underscores the rare but severe potential complications of MIS-C, including giant coronary aneurysms and recurrent disease.
  • Management involved a multidisciplinary approach with immunomodulatory therapies and careful monitoring of inflammatory markers.
  • Recommendations from the CDC-funded Clinical Immunization Safety Assessment Project guided the decision to defer further COVID-19 vaccination until inflammatory markers normalized.
Abstract

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