Case Report
Year: 2023 | Month: June | Volume: 10 | Issue: 6 | Pages: 600-605
DOI: https://doi.org/10.52403/ijrr.20230674
Multisystem Inflammatory Syndrome in Children (MIS-C) in Pediatric Patient Post Cardiac Surgery: A Case Report
Ni Putu Lisa Eka Pratiwi1, I Ketut Wibawa Nada1
1Anesthesiology and Intensive Care Department, Faculty of Medicine Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia
Corresponding Author: Ni Putu Lisa Eka Pratiwi
ABSTRACT
Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a relatively new disease associated with recent infection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2).
Case Report: We reported a 1-year-3-month-old girl with congenital heart disease since 1-month-old. Peripheral oxygen saturation was 89%, and systolic murmur was found from physical examination. Patient was assessed with ASA III physical status and planned to undergo re-route partial anomalous pulmonary venous return (PAPVR) and surgical atrial septal defect (ASD) closure under general anesthesia and cardiopulmonary bypass. During surgery, hemodynamic fluctuations were controlled. Post-operatively, she was transferred to the ICU, given sedation and analgesic. On night time, patient started to have fever with temperature 37.9⁰C. On the second day, patient had bradypneu, bradycardia, re-intubated and was given CPR. On the third day, patient’s SARS-CoV-2 Antibody was found to be reactive and diagnosis of MIS-C was made. On the fourth day, patient’s condition begin to deteriorate on even though she was given of Dobutamine, Epinephrine, Norepinephrine and Vasopressin. Four hours later, patient did not respond after CPR and declared deceased.
Discussion: Early recognition of MIS-C is challenging because the initial symptoms appear in previously healthy patient, with several symptoms such as fever, abdominal discomfort, mucocutaneous involvement, neurologic symptoms, cardiorespiratory symptoms (shock, myocarditis, dyspnea) with evidence of a marked inflammatory state. Immunomodulators are the mainstay of the treatment, with additional therapy such as steroids and anticoagulant. This severe disease’s mortality rate could be as high as 15% and more research must be done to better understand this disease.
Conclusion: MIS-C is a novel pediatric syndrome characterized by fever, multi-organ involvement and marked inflammatory state. Further study is required to provide consistent diagnosis criteria, therapy regimens, and long-term prognosis since this is a relatively new pediatric syndrome.
Keywords: Multisystem inflammatory syndrome in children (MIS-C), SARS-CoV-2, pediatric
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