Title of Case:

Intravenous administration of IL-1b blocker with excellent results in a case of MIS-C

Background:

Multisystemic inflammatory syndrome in children (MIS-C) is a new clinical entity associated with previous infection with Sars-Cov-2 which emerged during the pandemic. It is characterized by fever, increased inflammatory markers and multisystemic inflammation in the absence of an alternate diagnosis.

Case Presentation Summary:

A previously healthy 10-year-old boy was admitted with a 3 day history of unremitting high fever, morbiliform rash, diarrhea and abdominal pain. Upon admission, the patient was tachycardic, while non purulent conjunctivitis, generalized macular rash, red cracked lips, abdominal distention and tenderness were noted. Initial laboratory tests revealed increased inflammatory markers, mild thrombocytopenia and hyponatremia. Heart echo showed a small dilation of the main stem of the left coronary artery, while troponin and pro-BNP levels were elevated.

Despite prompt initiation of treatment with IVIG (2gr/kg) and methylprednisolone pulses, the patient’s clinical condition deteriorated on day 2 of his hospitalization. He developed limb and face edema and respiratory distress, accompanied with deterioration of inflammatory markers and hypoalbuminemia. Chest X-ray revealed left lung consolidation with pleural effusion. The abdominal ultrasound showed pericholocystic edema and eleitis. He was subsequently treated with intravenous Anakinra (8mg/kd/day). He showed excellent response with rapid improvement of clinical and laboratory findings and echcardiography. He was discharged in good clinical condition.

Learning Points/Discussion:

Prompt recognition and treatment of MIS-C are crucial in order to achieve better outcomes. In case of clinical deterioration whilst on maximum methylprednisolone regime, prompt initiation of IL-1b blocker via the intravenous route may radically ameliorate the outcome.