CASES OF THE WEEK - “A case of Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIM-TS) ” by Dr Wissam AlTamr, Specialist Paediatric Surgery & Dr Mohamed AlDisi, Consultant & HOD, Paediatrics, NMC Royal Hospital Sharj
A case of Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIM-TS)
4 year old female child was brought with complains of fever, vomiting, loose motions since 4 days. She developed maculopapular, erythematous rash all over the body 2 days before the admission. She presented with hypotension and was managed initially with fluid boluses and supportive treatment for the initial 15 hours in the ward and later was shifted to PICU in view of persisting hypotension.
Her initial investigations revealed elevated total count (neutrophilia with lymphopenia), thrombocytopenia, elevated CRP, PCT, serum ferritin and D-Dimers. Her troponin level and 2D ECHO was normal and liver function was deranged. Ultrasound was suggestive of features of cholecystitis. History of direct exposure to COVID 19 patients was not clear. Diagnosis of pediatric multi system inflammatory syndrome temporally associated with COVID 19 (PIMS-TS) was made.
She was managed with inopressor support, broad spectrum antibiotics, IVIG infusion and IV steroids. Etiological work up including COVID19 RT PCR was noncontributory. We tried to do COVID 19 antibody test however, it was unavailable. Gradually her blood pressure normalized and inopressors were tapered and stopped. Her fever and skin rash promptly responded to IVIG infusion. Over the next few days her blood reports also showed improvement.
She was shifted to ward on the 5th day of hospitalization and was discharged 2 days later from ward. On follow up she is doing well.
Paediatric multisystem inflammatory syndrome temporally associated with COVID 19 (PIMS-TS) is a new entity mainly described in Europe and USA. Only a limited number of cases have been reported till date worldwide. Diagnosis is mainly clinical (RT PCR for COVID 19 may be positive or negative) and it has very similar presentation like toxic shock syndrome (TSS) or Kawasakidisease shock syndrome(KDSS).
Various immunomodulatory drugs have been used including IVIG, Tocilizumab,Steroids, Anakinra. Our patients promptly responded to high dose IVIG along with IV steroids.
Probably, this is the first case reported in the UAE.