COVID 19 WITH MULTISYSTEM INFLAMMATORY SYNDROME
IN COLUMBIA ASIA PULOMAS HOSPITAL: A CASE REPORT
May Velyn Dina, Imelda Pingkan
Child Health Department, Columbia Asia Pulomas Hospital
OBJECTIVE
Multisystem inflammatory syndrome in children (MIS-C) is a condi-
tion where different body parts can become inflamed, including
the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal
organs. Children with MIS-C may have a fever and various symp-
toms, including abdominal (gut) pain, vomiting, diarrhea, neck
pain, rash, bloodshot eyes, or feeling extra tired.
CASE REPORT
A 11- years old boy presented to emergency department Columbia
Asia Pulomas hospital with fever since 4 days before, bloodshot
eyes, oedem palpebra, dizzy, redness on the abdomen and palm of
the hands. Sometimes feels difficult to breath. Cough (-)
On physical examination: oedem palpebra +/+, conjungtiva hypere-
mis +/+, enlarged lymph nodes at regio coli dextra. In pulmonary
examination: vesicular +/+, crackles +/+. macular erythema on
stomach and palm of the hands.
In laboratory findings: Leukocytosis 22.830, elevated of Neutrofil
88,1% and low Lymphocyte 7,0%. Hemoglobin, hematocrit, and
Trombosit were normal, SARS COV PCR detected.
In radiological finding: Bronchopneumonia, duplex pleural effu-
sion.
The patient then diagnosed as Confirmed covid 19 with Multisys-
tem Inflammatory Syndrome and hospitalized and got treatment
with Azithromycin 1x500 mg, Ceftriaxone injection 2x1 grams,
Oseltamivir 2x75 mg, Fluimucil 3x200 mg, zinc 1x20 mg, Vit D
2x1000 iu, Vit C 2x500 mg, Vit B Complex 1x1.
During hospitalized, this patient was checked D-dimer and the
result was 2920 ng/ml, leukocyte 19.340, Hemoglobin, Hematocrit,
and trombosit were normal. Because the D-dimer was high, the
patient treated with Diviti1x2.5 mg SC for 5 days as anticoagulant.
The patient was hospitalized for 10 days and checked D-dimer,
Leukocyte, Hemoglobin, Hematocrit, trombosit, and SARS COV PCR
for evalution and the result were normal so he can go home as
covid 19 discarded. Physical examination was normal.
DISCUSSION
The pathophysiology of MIS-C is not well understood. It is thought
to result from an abnormal immune response to the virus, with
some clinical similarities to KD, macrophage activation syndrome
(MAS), and cytokine release syndrome. However, MIS-C appears to
have an immunophenotype that is distinct from KD and MAS. Most
affected children have positive serology for SARS-CoV-2 with nega-
tive polymerase chain reaction (PCR), a finding that further
supports the hypothesis that MIS-C is related to immune disregula-
tion occurring after acute infection has passed. However, some
children do have positive PCR testing. In MIS-C causes hematostatic
changes such as elevated of D-dimer level. Infection of the respira-
tory system and endothelial cells by SARS-CoV-2 causes an intense
inflammatory response that includes the activation of the hemos-
tatic system, known as immunothrombosis or thromboinflam-
mation. The inflammatory process involving the vascular alveolar
endothelium, even in the initial stages, can trigger the formation of
pulmonary clots and neutrophil extracellular traps, which develop
to limit infection and viral spread.1,2,3
Hb 11,5
Ht 34,7
Leukocyte 9.960
Trombosit 450.000
Neutrofil 65,1
Lymphocyte 23,7
D-dimer 646
SARS COV PCR Not detected
CONCLUSIONS
Incidence of pediatric MIS-C, temporarily associated with SARS-CoV-2,
appears daily, calling pediatricians’ attentions to this new diagnosis
with more fatal outcomes than Kawasaki cases. The diagnosis is
challenging due to the variety of clinical and laboratory manifesta-
tions, with both positive and negative COVID-19 results, but that
should not delay therapy as soon as the diagnostic suspicion is genera-
ted.
REFERENCES
1. Carneiro J. D. A., et al. Proposed recommendations for antithrombo-
tic prophylaxis for children and adolescents with severe infection
and/or multisystem inflammatory syndrome caused by SARS COV 2.
Clinics 2020;75:e2252.
2. Rubens JH. Acute covid-19 multisystem inflammatory syndrome in
children. BMJ 2021;372:n385.
3. Hoste L, et al. Multisystem inflammatory syndrome in children
related to covid 19: a systematic review. Eur J Pediatr.