Difficulty in diagnosing and treating a child with multisystem inflammatory syndrome: a Case report
- Authors: Tulokhonova J.S.1, Obarchuk O.G.1, Averina I.A.1
-
Affiliations:
- Ivano-Matreninsky Children Hospital
- Issue: Vol 12, No 2 (2022)
- Pages: 223-232
- Section: Case reports
- URL: https://journal-vniispk.ru/2219-4061/article/view/123607
- DOI: https://doi.org/10.17816/psaic1018
- ID: 123607
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Abstract
This clinical observation is an example to show the complexity of diagnosing and treating children with SARS-CoV-2-associated multisystem inflammatory syndrome.
A 17-year-old patient who had a mild form of COVID-19 two weeks ago had a fever again and felt severe abdominal pain, and his general condition deteriorated rapidly. Moreover, on the fifth day from the onset of the disease, a child from the district hospital was admitted to the Ivano-Matreninsky Children’s Hospital in critical condition. Due to peritoneal symptoms, a diagnostic laparoscopy was performed to exclude acute surgical diseases which revealed mesadenitis and hydroperitoneum. Subsequently, the patient had a prolonged fever, severe multiple organ failure developed, including myocarditis with damage to the conduction system of the heart and a marked decrease in the left ventricular ejection fraction, bilateral pneumonia, hydroperitoneum and hydrothorax, acute kidney injury, lymphopenia, thrombocytopenia, coagulopathy, increased markers of inflammation. Non-invasive artificial lung ventilation was performed for 3 d. On day 10, an atrial temporary pacing system was installed, removed 11 d after heart rhythm normalization, and the pleural cavity was drained due to spontaneous pneumothorax. There was a gradual positive trend in respiratory status, the state of the cardiovascular system, normalization of laboratory parameters, and a decrease in inflammation markers. The patient was discharged from the hospital in a satisfactory condition on day 39.
This clinical case demonstrates a severe course of childhood inflammatory, multisystem syndrome with multiple organ failure. The peculiarities of the case include the severity of abdominal pain syndrome, requiring laparoscopy, impaired cardiac activity, and requiring a pacemaker for 11 days.
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##article.viewOnOriginalSite##About the authors
Julia S. Tulokhonova
Ivano-Matreninsky Children Hospital
Author for correspondence.
Email: se_yu@mail.ru
ORCID iD: 0000-0003-3220-9549
SPIN-code: 4131-3115
anesthesiologist-resuscitator
Russian Federation, IrkutskOksana G. Obarchuk
Ivano-Matreninsky Children Hospital
Email: oxya_ne@mail.ru
ORCID iD: 0000-0002-5541-7335
SPIN-code: 3953-2692
anesthesiologist-resuscitator
Russian Federation, IrkutskIrina A. Averina
Ivano-Matreninsky Children Hospital
Email: nsaplina@rambler.ru
ORCID iD: 0000-0003-1527-7005
SPIN-code: 1907-1447
anesthesiologist-resuscitator
Russian Federation, IrkutskReferences
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