A rare case of cutaneous vascular phenomena and fulminant cardiac involvement in paediatric multisystem inflammatory syndrome in children following asymptomatic COVID-19 exposure in a 7-year-old child

Abstract

Multisystem inflammatory syndrome in children is a systemic disorder that involves incessant fever, extreme inflammation, and organ dysfunction, which is at first associated with exposure to COVID-19. This case, however, presents a unique twist. A 7-year-old paediatric patient, initially presenting with fever and rash, exhibited a polymorphous rash varying from macular to maculopapular, with a cutis marmorata-like appearance, particularly on the extremities. What followed was a rapid deterioration, with the patient developing tachypnoeic respiration and moderate hypotension (80/35 mm Hg). Elevated D-dimer levels, troponin, ferritin, a low platelet count, a low albumin level, and lymphopenia were detected, further complicating the case. This unique case challenges our understanding of multisystem inflammatory syndrome in children and prompts further investigation. Despite the severity of the case, the patient’s condition improved significantly with treatment. The patient’s COVID-19 polymerase chain reaction test was negative, but the COVID-19 immunoglobulin G test was positive. Transthoracic echocardiography demonstrated a mild/moderate systolic dysfunction of the left ventricular (Ejection fraction 52%, SF 25%), echogenicity of coronary vessels, and a first-degree mitral insufficiency was detected. Thorax CT showed pulmonary oedema. Milrinone and noradrenaline were promptly started for hemodynamic support. Intravenous immunoglobulin, methylprednisolone, favipiravir, and anakinra were started for his treatment. On the second day of hospitalisation, the patient’s condition was ameliorated. On the 10th day of hospitalisation, the patient was discharged from the hospital, marking a successful recovery from a complex and severe case. This successful recovery serves as a beacon of hope in the management of multisystem inflammatory syndrome in children.