Fatal SARS-CoV-2 Inflammatory Syndrome and Myocarditis in an Adolescent: A Case Report

Jeanette T. Beaudry; Barbara Dietrick; Dawn B. Lammert; Alexander Constas; Julia McCaw; John Hammond; Matthew Buendia; Julie E. Stein; Andrew Pekosz; Jennifer Schuette; Heba H. Mostafa; Jody Hooper; Meghan Bernier; Allison Agwu; Leonard S. Feldman

doi:10.1097/INF.0000000000002978

Fatal SARS-CoV-2 Inflammatory Syndrome and Myocarditis in an Adolescent: A Case Report

Jeanette T. Beaudry, Barbara Dietrick, Dawn B. Lammert, Alexander Constas, Julia McCaw, John Hammond, Matthew Buendia, Julie E. Stein, Andrew Pekosz, Jennifer Schuette, Heba H. Mostafa, Jody Hooper, Meghan Bernier, Allison Agwu, Leonard S. Feldman

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. Methods: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. Results: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. Conclusions: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.

Original language	English (US)
Pages (from-to)	E72-E76
Journal	Pediatric Infectious Disease Journal
DOIs	https://doi.org/10.1097/INF.0000000000002978
State	Published - Feb 1 2021

Keywords

adolescent
coronavirus disease 2019
inflammatory syndrome
multi-inflammatory syndrome in children
pediatric
severe acute respiratory syndrome coronavirus 2

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Microbiology (medical)
Infectious Diseases

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10.1097/INF.0000000000002978

Cite this

Beaudry, J. T., Dietrick, B., Lammert, D. B., Constas, A., McCaw, J., Hammond, J., Buendia, M., Stein, J. E., Pekosz, A., Schuette, J., Mostafa, H. H., Hooper, J., Bernier, M., Agwu, A., & Feldman, L. S. (2021). Fatal SARS-CoV-2 Inflammatory Syndrome and Myocarditis in an Adolescent: A Case Report. Pediatric Infectious Disease Journal, E72-E76. https://doi.org/10.1097/INF.0000000000002978

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abstract = "Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. Methods: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. Results: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. Conclusions: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.",

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author = "Beaudry, {Jeanette T.} and Barbara Dietrick and Lammert, {Dawn B.} and Alexander Constas and Julia McCaw and John Hammond and Matthew Buendia and Stein, {Julie E.} and Andrew Pekosz and Jennifer Schuette and Mostafa, {Heba H.} and Jody Hooper and Meghan Bernier and Allison Agwu and Feldman, {Leonard S.}",

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AU - Dietrick, Barbara

AU - Lammert, Dawn B.

AU - Constas, Alexander

AU - McCaw, Julia

AU - Hammond, John

AU - Buendia, Matthew

AU - Stein, Julie E.

AU - Pekosz, Andrew

AU - Schuette, Jennifer

AU - Mostafa, Heba H.

AU - Hooper, Jody

AU - Bernier, Meghan

AU - Agwu, Allison

AU - Feldman, Leonard S.

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N2 - Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. Methods: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. Results: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. Conclusions: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.

AB - Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. Methods: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. Results: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. Conclusions: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.

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Fatal SARS-CoV-2 Inflammatory Syndrome and Myocarditis in an Adolescent: A Case Report

Abstract

Keywords

ASJC Scopus subject areas

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