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Cardiac manifestations and short-term outcomes of multisystem inflammatory syndrome in Middle Eastern children during the COVID-19 pandemic: a case series

Published online by Cambridge University Press:  17 June 2021

Theresia E. Tannoury ,
Ziad R. Bulbul Open the ORCID record for Ziad R. Bulbul [Opens in a new window]  and
Fadi F. Bitar Open the ORCID record for Fadi F. Bitar [Opens in a new window]
Theresia E. Tannoury
Affiliation:
Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Ziad R. Bulbul*
Affiliation:
Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Fadi F. Bitar
Affiliation:
Children’s Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
*
Author for correspondence: Dr Z. Bulbul, MD, Department of Pediatrics and Adolescent Medicine, American University of Beirut, PO Box 11-0236, Riad-El Solh St., Beirut, 1107 2020, Lebanon. Tel: +9 617 679 3838; Fax: +961370781. E-mail: ziad.bulbul@abu.edu.lb.
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Abstract

We herein report on a series of four patients presented to our tertiary care centre with features of multisystem inflammatory syndrome in children and cardiac involvement. Two of our patients had recent exposure to a COVID-19-positive patient, one had recent documented infection, and another had no known positive contact. All the patients were tested positive for severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibody at the time of presentation. All of them fulfilled the diagnostic criteria according to the World Health Organization Centers for Disease Control or the British guidelines for MIS-C (fever for ≥3 days, multisystem involvement (at least two), elevated markers of inflammation, and no other alternative diagnosis).

Cardiac involvement was variable ranging from isolated ectasia of the coronary arteries to full-blown pancarditis such as severe biventricular dysfunction, multi-valvar involvement, and pericardial effusion.

All our patients received intravenous immunoglobulin (2 g/kg), methylprednisolone, and aspirin and some required inotropic support and ICU admission.

Remarkably, all our patients showed significant improvement in their cardiac disease within a few days as evident on serial echocardiographic evaluation. However, we stress the need for long-term follow-up as one of our patients demonstrated mild LV myocardial scarring as evident by gadolinium late enhancement on a cardiac MRI.

Keywords

Multisystem inflammatory syndrome in children (MIS-C)cardiac manifestationsCOVID-19coronary involvementmyocardial dysfunction
Type
Brief Report
Information
Cardiology in the Young , Volume 32 , Issue 1 , January 2022 , pp. 165 - 168
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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