Kawasaki-like disease and acute myocarditis in the SARS-CoV-2 pandemic – reports of three adolescents

  • Stasa Krasic Cardiology Department, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia https://orcid.org/0000-0002-3007-5631
  • Sergej Prijic Cardiology Department, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
  • Predrag Minic School of Medicine, University of Belgrade, Belgrade, Serbia; Pulmonology Department, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
  • Gordana Petrovic Immunology Department, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia https://orcid.org/0000-0001-9115-7481
  • Dejan Nesic School of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Medical Physiology "Rihard Burian", Belgrade, Serbia https://orcid.org/0000-0002-7794-3520
  • Aleksandra Paripovic Pediatric Clinic, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
  • Milena Vasiljevic Pediatric Clinic, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
  • Borko Gobeljic Pediatric Clinic, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
  • Vladislav Vukomanovic Cardiology Department, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia https://orcid.org/0000-0002-5244-1436
Keywords: SARS-CoV-2, myocarditis, Kawasaki disease, adolescent, COVID-19

Abstract

The novel coronavirus disease (COVID-19) may induce multisystem inflammatory syndrome in children, which may be associated with Kawasaki-like disease and cardiac injury. In this study, we present three male adolescents with multisystem inflammatory syndrome and myocardial injury admitted to the hospital during the peak of COVID-19 pandemic. All of the three patients had a history of fever, gastrointestinal symptoms, polymorph rash, non-exudative conjunctivitis, and signs of acute myocarditis. One of them had renal failure. Previously, they did not have an acute infection. Upon admission, they were hypotensive and tachycardic. A nasopharyngeal swab for SARS-CoV-2 on reverse transcription-polymerase chain reaction (PCR) assay was negative, but neutralizing viral antibodies were positive. In combination with blood tests, ECG, echocardiography, and computerized tomography (CT), a multisystem inflammatory syndrome associated with acute myocarditis with mild to moderate systolic dysfunction and dilated coronary arteries were diagnosed. Two of three patients had shock syndrome and required inotropic support. All patients were treated with intravenous immunoglobulins. The second patient had a fever up to 102.2°F (39°C) 3 days after intravenous application of immunoglobulins. Further, he was treated according to protocols for refractory Kawasaki disease, with an intravenous methylprednisolone pulse therapy and aspirin. After a few hours, he became afebrile and the clinical signs disappeared. The favorable short-term outcome may reflect early recognition and adequate therapy; however, the long-term outcomes are currently unknown.

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Kawasaki-like disease and acute myocarditis in the SARS-CoV-2 pandemic – reports of three adolescents
Published
2020-10-16
How to Cite
1.
Krasic S, Prijic S, Minic P, Petrovic G, Nesic D, Paripovic A, Vasiljevic M, Gobeljic B, Vukomanovic V. Kawasaki-like disease and acute myocarditis in the SARS-CoV-2 pandemic – reports of three adolescents. Bosn J of Basic Med Sci [Internet]. 2020Oct.16 [cited 2020Nov.28];. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/5037
Section
Case reports