key: cord-0800608-7ewk0oik
authors: Choudhary, Abhijit; Jain, Shikha; Khemka, Nishu; Chauhan, Urmila; Bang, Akash; Girish, Meenakshi; Makode, Sagar
title: ST Elevation Acute Myocardial Infarction (STEMI) in a Child with Multisystem Inflammatory Syndrome
date: 2022-04-23
journal: Indian J Pediatr
DOI: 10.1007/s12098-022-04192-2
sha: 95f51f969c3d2b2d264f7845d73e5fe670df5abe
doc_id: 800608
cord_uid: 7ewk0oik

nan

To the Editor: A 10-y-old boy, suffering from Duchenne muscular dystrophy, presented with high-grade fever, bilateral nonpurulent conjunctival congestion and erythroderma. The child was ambulatory on wheelchair since last 6 mo, on low-dose oral steroids, and his echocardiography done 2 mo prior was normal. Investigations showed neutrophilic leukocytosis, positive IgG COVID-19 antibody, CRP -128.38 mg/L, D-dimer -1980 ng/Ml, and troponin I negative. MIS-C KD phenotype was considered. Baseline ECG and echocardiography were normal. Child was treated with IVIG 2 g/kg, IV methylprednisolone, aspirin, and prophylactic LMWH. He became afebrile with improved general wellbeing. On day 4, child developed severe precordial chest pain, ECG was suggestive of STEMI, and echocardiography showed inferolateral wall motion abnormality with an ejection fraction of 45%. Loading dose of aspirin was administered and thrombolysis done with streptokinase. ECG at 3 h after fibrinolysis showed resolution of ST segment by 50% in the affected leads. Diagnostic coronary angiography 3 h after thrombolysis showed no evidence of reduced flow in the infarct-related regions. LMWH was continued at therapeutic doses with dual platelet therapy. On follow-up at 3 mo, child was stable with normal echocardiography and ECG.

Cardiac involvement is not uncommon in pediatric MIS-C. Valverde et al. reported shock, cardiac arrhythmia, pericardial effusion, and coronary artery dilatation as the four most common complications in their cohort of children with MIS-C [1] . Myocardial infarction has only been reported once, but in the background of significant dilatation of the left descending coronary artery [2] . In our case, cardiac function and coronaries were normal and STEMI developed in the background of a normal heart. MIS-C is known to lead to prothrombotic state in children [3] but this is the first reported case of myocardial infarction in a child with MIS-C with normal coronaries, and highlights the importance of strict vigilance in such cases.

Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe

Inflammatory syndrome in children associated with COVID-19 complicated by acute myocardial infarction

Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C