key: cord-0934501-luvbz1ym
authors: Villacis-Nunez, D. Sofia; Hashemi, Sassan; Nelson, Meghan C.; Flanagan, Elaine; Thakral, Amit; Rodriguez, Fred; Jaggi, Preeti; Oster, Matthew E.; Prahalad, Sampath; Rouster-Stevens, Kelly A.
title: Giant Coronary Aneurysms in Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection
date: 2021-10-06
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2021.06.043
sha: 292195034914e6ad69989df6e5f7c9e86e66075b
doc_id: 934501
cord_uid: luvbz1ym

Multisystem inflammatory syndrome in children (MIS-C) can cause a myriad of cardiac manifestations, including coronary dilation and aneurysms; giant aneurysms are infrequent. We describe 3patients with giant coronary aneurysms associated with MIS-C, including the youngest case reported to date, treated with intravenous immunoglobulin, corticosteroids, and biologic agents. (Level of Difficulty: Intermediate.)

(MIS-C) following severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) infection has been linked to various cardiac manifestations (1, 2) .

We report 3 cases of MIS-C complicated by giant coronary aneurysms. Relevant laboratory values are shown in Table 2 . Hypotension and desaturations during IVIG infusion required transfer to intensive care and a low-flow nasal cannula. Pulse IVMP was initiated (days 7-9) for persistent fever. By day 9, he was on room air, hemodynamically stable, and afebrile. As evidenced by our case series, the use of biologic agents for MIS-C has not been standardized.

Infliximab has been used for MIS-C-related aneurysms, with partial or complete reversibility of the coronary changes (4,5,7). Interleukin-1 (anakinra) and interleukin-6 (tocilizumab) blockade has been used in refractory MIS-C; these agents were used successfully in Patient 3 (2) . Multicenter studies are needed to determine the most effective therapies

for MIS-C. Long-term outcomes are still to be determined, and multispecialty follow-up is essential. 

Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach

Review of cardiac involvement in multisystem inflammatory syndrome in children

COVID-19-associated multisystem inflammatory syndrome in children-United States

Clinical characteristics of 10 children with a pediatric inflammatory multisystem syndrome associated with COVID-19 in Iran

Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2

Hyperinflammatory shock in children during COVID-19 pandemic

Multisystem inflammatory syndrome in children: an international survey. Pediatrics

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

American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 2

Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study

KEY WORDS COVID-19, giant coronary aneurysms, multisystem inflammatory syndrome in children, SARS-CoV-2 APPENDIX For supplemental videos, please see the online version of this paper