Observation of severe pediatric inflammatory multisystem syndrome associated with COVID-19

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


One of the rare manifestations of COVID-19 is pediatric inflammatory multisystem syndrome, most often in publications it is found out how pediatric inflammatory multisystem syndrome in children (РIMS). The progression of the inflammatory response in РIMS may be a consequence of the development of secondary hemophagocytic syndrome, a significant part of which is refractory fever, an increase in ferritin, AST and ALT, cytopenia, an increase in interleukin 6, severe hepatic and neurological dysfunction. The case with this group of representatives of other multiple organ failure manifestations in the detection of acute distress syndrome and acute heart failure, in the detection of the development of myocarditis.

A feature of the described clinical detection is the dynamic observation of a severe pediatric multisystem inflammatory syndrome associated with COVID-19, complicated by myocarditis with acute heart failure, left ventricular dysfunction and secondary hemophagocytic syndrome, in an 11-year-old girl with underlying obesity. The child is taking triple therapy with glucocorticosteroids in combination with intravenous immunoglobulin and cyclosporine A, with an expected effect on the ongoing treatment. Possible features of observation are noted: 1) a very early start of РIMS during the acute phase of СOVID-19; 2) transient dyslipidemia at the onset of РIMS with an increase in cholesterol, mainly due to the low-density lipoprotein fraction, and spontaneous regression without lipid-lowering drugs; 3) MRI signs of myocarditis in a month after the onset of the disease, despite the normalization of echocardiography and pro-BNP.

Full Text

Restricted Access

About the authors

Olesya S. Efremova

Irkutsk State Medical Academy of Postgraduate Education, branch of Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: shaguno@mail.ru
ORCID iD: 0000-0001-7066-9138

assistant of the Department of pediatrics, cardiologist

Russian Federation, Irkutsk

Lyudmila V. Bregel

Irkutsk State Medical Academy of Postgraduate Education, branch of Russian Medical Academy of Continuous Professional Education

Email: loudmilabregel@yandex.ru
ORCID iD: 0000-0002-7668-1282

MD, PhD, Dr. Sci. (Med.), professor, head of the Department of pediatrics

Russian Federation, Irkutsk

Natalia Yu. Rudenko

Irkutsk State Regional Children’s Clinical Hospital

Email: nata.rudenko.65@inbox.ru
ORCID iD: 0000-0001-5795-6992

deputy chief medical officer

Russian Federation, Irkutsk

Natalya A. Kniazeva

Irkutsk State Regional Children’s Clinical Hospital

Email: nata.rudenko.65@inbox.ru
ORCID iD: 0000-0002-9099-6803


Russian Federation, Irkutsk

Mikhail M. Kostik

St. Petersburg State Pediatric Medical University

Email: kost-mikhail@yandex.ru
ORCID iD: 0000-0002-1180-8086

MD, PhD, Dr. Sci. (Med.), professor of the Department of hospital pediatrics

Russian Federation, Saint Petersburg


  1. Minzdrav Rossii. Metodicheskie rekomendatsii “Osobennosti klinicheskikh proyavlenii i lecheniya zabolevaniya, vyzvannogo novoi koronavirusnoi infektsiei (COVID-19) u detei”. Versiya 2. (In Russ.) 3 July 2020.
  2. Buda P, Strauss E, Januszkiewicz-Lewandowska D, et al. Clinical characteristics of children with MIS-C fulfilling classification criteria for macrophage activation syndrome. Front Pediatr. 2022;10:981711. doi: 10.3389/fped.2022.98171
  3. Cena H, Fiechtner L, Vincenti A, et al. COVID-19 pandemic as risk factors for excessive weight gain in pediatrics: The role of changes in nutrition behavior. A Narrative Review. Nutrients. 2021;13(12):4255. doi: 10.3390/nu13124255
  4. Dufort EM, Koumans EH, Chow EJ, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383:347–358. doi: 10.1056/NEJMoa2021756
  5. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334. doi: 10.1056/NEJMoa2021680
  6. Gowin E, Toczyłowski K, Sulik A, et al. The role of glucocorticoids in the treatment of multisystem inflammatory syndrome (MIS-C)-data from POLISH MIS-C Registry. Children (Basel). 2022;9(2):178. doi: 10.3390/children9020178
  7. Grzegorowska O, Lorkowski J. Possible Correlations between Atherosclerosis, Acute Coronary Syndromes and COVID-19. J Clin Med. 2020;9(11):3746. doi: 10.3390/jcm9113746
  8. Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology Clinical Guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: Version 1. Arthritis Rheumatol. 2020;72(11):1791. doi: 10.1002/art.41454
  9. Henter J-I, Horne AC, Aricó M, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48(2):124–131. doi: 10.1002/pbc.21039
  10. Supriya J, Sheila NM, Aalok SR, et al. Myocarditis in multisystem inflammatory syndrome in children associated with coronavirus disease 2019. Cardiol Rev. 2020;28(6): 308–311. doi: 10.1097/CRD.0000000000000341
  11. McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis — a critical review of its pathogenesis and treatment. Front Pediatr. 2020;8:626182. doi: 10.3389/fped.2020.626182
  12. Ravelli A, Minoia F, Davì S, et al. Expert consensus on dynamics of laboratory tests for diagnosis of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis. RMD Open. 2016;2(1): e000161. doi: 10.1136/rmdopen-2015-000161
  13. Saha S, Pal P, Mukherjee D. Neonatal MIS-C: managing the cytokine storm. Pediatrics. 2021;148(5): e2020042093. doi: 10.1542/peds.2020-042093
  14. Knox SK, Mahr TA. Treatment of multisystem inflammatory syndrome in children. Pediatrics. 2022;150(S3): S67. doi: 10.1542/peds.2022-059346WWWW
  15. Shi Z, Jiang Y, Weir-McCall J, et al. COVID-19 and atherosclerosis: looking beyond the acute crisis. Emergency Crit Care Med. 2022;2(1):1–4. doi: 10.1097/EC9.0000000000000031
  16. Son MBF, Berbert L, Young C, et al. Postdischarge glucocorticoid use and clinical outcomes of multisystem inflammatory syndrome in children. JAMA Netw Open. 2022;5(11): e2241622. doi: 10.1001/jamanetworkopen.2022.41622
  17. Vinciguerra M, Romiti S, Sangiorgi GM, et al. SARS-CoV-2 and atherosclerosis: should COVID-19 be recognized as a new predisposing cardiovascular risk factor? J Cardiovasc Dev Dis. 2021;8(10):130. doi: 10.3390/jcdd8100130
  18. Wu EY, Campbell MJ. Cardiac manifestations of multisystem inflammatory syndrome in children (MIS-C) following COVID-19. Curr Cardiol Rep. 2021;23(11):168. doi: 10.1007/s11886-021-01602-3

Copyright (c) 2023 Eco-Vector

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 69634 от 15.03.2021 г.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies