A severe case of mis-c and acute heart failure with rapid recovery

AIMS & OBJECTIVES: Multisystem inflammatory syndrome in children (MIS-C) is a severe Kawasaki-like disease seen in a fraction of children with SARS-COV-2 The syndrome's sequelae are still being defined We present a 17-year-old female with MIS-C and acute biventricular heart failure (BVHF) We highlight her presentation, clinical course, management, and outcomes METHODS: Design: Case report Setting: Pediatric intensive care unit (PICU) in an academic hospital Participant: 17-yearold female with MIS-C and BVHF RESULTS: A 17-year-old overweight female with asthma was admitted to the PICU with MIS-C A history of SARS-COV-2 infection was confirmed with positive nasopharyngeal swab and IgG antibody and borderline IgM antibody She presented with hypotension, fevers, abdominal pain, myalgias, and headache, but no chest pain Initial diagnostic studies were notable for troponin I 2 572 ng/ml, BNP 386 pg/mL, ECG with sinus tachycardia, and echocardiogram with normal function Over two days her hypotension worsened despite increasing vasoactive therapy Repeat echocardiogram revealed LVEF 30% and moderate right systolic dysfunction consistent with acute heart failure She received intravenous immune globulin (400 mg/kg) once, dexamethasone (6 mg daily), and Tocilizumab Within 48 hours of these treatments she was weaned off all vasoactive therapies and extubated Repeat echocardiogram near time of discharge showed improved LVEF 55% She was discharged home after 8 days CONCLUSIONS: MIS-C is a severe hyperinflammatory disease in a fraction of pediatric patients with COVID-19 Acute heart failure is a known, but uncommon, devastating complication of MIS-C that may resolve with prompt and aggressive treatment of the underlying hyperinflammatory syndrome