key: cord-1022210-pzl9o0zg
authors: Yadav, Anjali; Thakkar, Dhwanee; Upasana, K.; Arora, Sunisha; Rastogi, Neha; Yadav, Satya Prakash
title: Post COVID-19 multisystem inflammatory syndrome in children undergoing hematopoietic stem cell transplant
date: 2021-11-17
journal: Pediatric Hematology Oncology Journal
DOI: 10.1016/j.phoj.2021.11.005
sha: 2ceb05adb717b30b46e2b1d914fa7428e625370c
doc_id: 1022210
cord_uid: pzl9o0zg

nan

To the editor:

There is paucity of literature on outcomes of Post COVID-19 Multisystem inflammatory syndrome in Children (MIS-C) in pediatric hematopoietic stem cell transplant (HSCT) recipients.

Here we report two cases of MIS-C in post HSCT. dropped to 80-85% on room air, BP 98/60 mmHg, respiratory rate of 48/minute and heart rate of 148/minute. A Chest X-ray (CXR) was done which showed bilateral middle zone haziness in lungs. Venous blood gas (VBG) was done which was suggestive of normal pH but lactate was slightly raised (3.7mmol/L). Child was started on supplemental oxygen by mask at 4 L/minute, with which 90-95% SpO2 could be achieved. RT PCR for SARS-CoV-2 was repeated which was negative for active infection. Child was then shifted to Pediatric Intensive Care Unit (PICU). His respiratory distress further worsened and he was started on Oxygen support by High Flow Nasal cannula (HFNC) with flow rate of 20L/minute and FiO2 of 60%. Inflammatory markers were J o u r n a l P r e -p r o o f raised, Ferritin was 6370ng/ml, C-reactive protein (CRP) was 45.8mg/L. His NT pro-BNP-1860 pg/ml, D-Dimer-1117ng/ml were raised. In view of raised inflammatory markers and recent history of COVID-19, possibility of MIS-C was considered. IV methylprednisolone pulse at the dose of 20mg/kg body weight was started. Intravenous immunoglobulin (IVIG) at dose of 1gram/kg was also given. He received packed red blood cells and platelet support. Gradually his respiratory distress started settling from day 7 of this MIS-C illness and his laboratory parameters started showing improvement. His TLC declined from 2640/μL to lowest of 450/μL. His platelets stayed in the range of 4,000 to 13,000/μL with supportive care. The lowest recorded S. Albumin was 2.45 gm/dL. CMV PCR was negative. His blood culture did not grow any organism. After giving Methylprednisolone at 20mg/kg for 4 days, steroids were tapered off to 10mg/kg for 2 days, followed by 3mg/kg for 2 days and then tapered off over next 10 days. Child was shifted to ward once off oxygen. Child was discharged in stable condition after 10 days of hospitalisation. Now he is one month post discharge and doing well.

An 11-years old girl, case of acute lymphoblastic leukemia in complete remission-2 post matched sibling donor HSCT and chronic graft vs. host disease (GVHD) of skin presented on day + 382 with complaints of cough, shortness of breath and tiredness for 2 days. She also had one episode of haemoptysis at home. For chronic GVHD, she was on oral Sirolimus (1mg/day), prednisolone (1mg/kg/day) and Ruxolitinib (5mg twice a day). At presentation to hospital, on examination, child had respiratory distress with SpO2-70% on room air, tachycardia, tachypnoea, BP was

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