key: cord-0731914-kwxg4dg9
authors: Wadhawan, Pallavi; Chavan, Bhushan; Patil, Shekhar
title: Stroke with Myocarditis: A Different Post-COVID Syndrome
date: 2022-01-04
journal: Indian J Pediatr
DOI: 10.1007/s12098-021-04028-5
sha: 0495b7bbbb935ee45e547a5054687d9cee8f12e4
doc_id: 731914
cord_uid: kwxg4dg9

nan

To the Editor: Initially, COVID-19-infected children were considered spared from life-threatening complications but continuance of the pandemic exposed diverse presentations of multiple post-COVID complications like MISC [1] . We report a previously healthy, vitally stable 2-y-old girl child who developed sudden onset weakness of right upper and lower limb. An urgent MRI of the brain revealed multiple fresh nonhemorrhagic infarcts associated with luminal irregularities in the left middle cerebral artery bifurcation. 2D-ECHO as part of the stroke workup revealed moderate left ventricular dysfunction with an ejection fraction of 30%-35%. Considering the pandemic, COVID-19 antibodies along with inflammatory markers, D-dimer, and NT proBNP levels were sent which confirmed our suspicion of a post-COVID hyperinflammatory response. Consistent with the MIS-C guidelines, a short course of high-dose steroids (methylprednisolone) with injection enoxaparin were prescribed. Diuretics furosemide and spironolactone were started at doses of 1 mg/kg/d along with aspirin at 3 mg/kg/d for anticoagulation. She remained active, playful with improved limb movements following physiotherapy. On sequential echocardiography at 6 mo, a complete normalization of cardiac function was noted. Repeat MRI at half-yearly follow-up exhibited previous infarct sequalae as minimal gliosis with no new additional changes ruling out previous varicella infection as the cause. Cumulative data highlight the appearance of manifestations of post-COVID syndromes as an evolving condition with frequently changing guidelines [2] . We want clinicians to suspect post-COVID syndrome in children presenting with new-onset multisystemic symptoms with positive inflammatory markers especially in the complete absence of fever.

Ethics Approval Taken.

Due verbal and written informed consent was taken from both parents.

None.

COVID-19 and multisystem inflammatory syndrome in children and adolescents

COVID-19 associated arterial ischaemic stroke and multisystem inflammatory syndrome in children: a case report

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