Title : Multisystem inflammatory syndrome in children after cardiac surgery: Three pediatric case reports
Abstract:
Introduction: SARS-CoV-2 usually causes mild symptoms in children, but the infection can lead to the development of severe Multisystem Inflammatory Syndrome in Children (MIS-C), with significant long-term complications, as first reported in April 2020.
Objective: To describe three postoperative cardiac surgery cases in which MIS-C was considered as a differential diagnosis.
Discussion:
Case 1: A.P.F.S.M., an 8-year-old female, underwent surgical correction of an atrial septal defect and was discharged with good postoperative progress. Fifteen days later, she returned with complaints of respiratory distress, cough, and fever. Her condition rapidly worsened and was refractory to antibiotic therapy. She presented with persistent fever, diffuse skin rash, conjunctivitis, mucositis, persistently elevated inflammatory markers, pancytopenia, and myocarditis. A previous RT-PCR test for SARS-CoV-2 had been positive one month earlier.
Case 2: A.L.L.N., a 1-year-and-5-month-old male, was diagnosed with aortic coarctation. He underwent end-to-end aortoplasty with ligation and division of the ductus arteriosus. The patient developed clinical deterioration, including persistent fever four days after the procedure, elevated inflammatory markers, cardiovascular dysfunction, and shock requiring vasoactive drugs. Blood cultures were negative, and no infectious focus was identified. A previous RT-PCR test for SARS-CoV-2 was positive one month earlier.
Case 3: I.H.A.S., an 8-month-old female with an atrioventricular septal defect, underwent pulmonary artery banding and ductus arteriosus ligation. She developed persistent fever, severe shock requiring vasoactive drugs and noninvasive ventilation, as well as persistent coagulation abnormalities, including elevated D-dimer and troponin levels. A previous RT-PCR test for SARS-CoV-2 was positive one month earlier.
Results: The three patients received a clinical and laboratory diagnosis of MIS-C and were treated with 2 g/kg of immunoglobulin and corticosteroids. They showed clinical improvement and were subsequently discharged from the hospital.
Conclusion: MIS-C is a serious and potentially fatal condition, and diagnosis by exclusion is of paramount importance in these patients to enable targeted treatment and prevent an unfavorable clinical outcome. The favorable outcome in these patients is directly linked to early diagnosis and appropriate treatment, as demonstrated by the cases described.
