EP525 - A CAUTIONARY TALE ON THE ADVERSE EFFECTS OF HIGH-DOSE STEROID USE IN CHILDREN WITH PIMS-TS (ID 467)
Abstract
Title of Case:
Upper Gastrointestinal Bleed in a patient with PIMS-TS
Background:
COVID-19 has led to the emergence of Paediatric Inflammatory Multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), which clinically resembles Kawasaki Disease and Toxic Shock Syndrome. Standard clinical practice is being developed, with intravenous immunoglobulin, high-dose steroids, and supportive measures as the mainstay treatment. Here, we highlight the risk of high-dose steroid therapy in children.
Case Presentation Summary:
A 7-year-old, previously healthy, girl presented with a five-day history of fever, abdominal pain, conjunctivitis, maculopapular rash and bilateral periorbital swelling. She was resuscitated with 3 intravenous fluid boluses and started on intravenous immunoglobulin, oral high-dose aspirin, and omeprazole. A positive COVID-19 antibody test later confirmed the diagnosis of PIMS-TS. She became hypotensive despite initial treatment and was transferred to PICU, where she received 10mg/kg intravenous methylprednisolone and 0.5 mcg/kg/min of noradrenaline. She was stepped down to the ward the following day to complete 3 days of methylprednisolone with oral lansoprazole for gastroprotection and prophylactic dalteparin. Upon completion, she experienced intermittent abdominal pain and 3 episodes of melaena. Despite being haemodynamically stable, her haemoglobin dropped from 80mg/dl three days ago to 43mg/dl with a normal clotting profile, necessitating 2 units of blood transfusion. An urgent OGD visualised a 0.5cm ulcer in the gastric antrum covered in fibrin, which was treated with adrenaline. Thereafter, she improved on intravenous esomeprazole and was discharged after three days, with an interval OGD arranged in six weeks.
Learning Points/Discussion:
Although stress ulcers, a known complication in PICU patients, remain a differential, clinicians should be vigilant around the side effect of upper gastrointestinal bleed from high-dose steroid therapy in this patient cohort. Future clinical trials for PIMS-TS should include detailed information on adverse outcomes from therapeutic strategies.
