Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Treated With Infliximab
Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Treated With Infliximab
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DOI：
10.1097/mpg.0000000000002809
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发表时间：
2020-08-01
影响因子：
2.9
通讯作者：
Lai, Joanne
中科院分区：
文献类型：
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作者：
Dolinger, Michael T.;Person, Hannibal;Lai, Joanne
2019冠状病毒病（COVID-19）可能导致严重的炎症反应，称为细胞因子风暴。我们描述了一例最近确诊的儿童克罗恩病患者严重COVID-19感染的病例，该患者成功接受了肿瘤坏死因子-α（TNF-α）阻断治疗。患者出现发热5天、面部红斑性斑丘疹和腹痛，无呼吸道症状。SARS-CoV-2聚合酶链反应阳性。尽管住院治疗COVID-19和肛周脓肿，但患者急性失代偿，发热恶化，心动过速，液体难治性低血压，肝酶升高，皮疹转化为紫癜，从面部延伸到躯干，上肢和下肢，包括手和脚的手掌和足底面。细胞因子谱显示白细胞介素（IL）-6，IL-8和TNF-α水平升高，高于炎症性肠病或严重COVID-19单独描述的水平。该患者接受英夫利西单抗治疗，用于TNF-α阻断，以解决与COVID-19暂时相关的儿童中重度活动性克罗恩病和多系统炎症综合征。英夫利西单抗治疗后数小时内，发热、心动过速和低血压消退。细胞因子谱随着TNF-α的正常化、IL-6和IL-8浓度的降低而改善。该病例支持阻断TNF-α在治疗COVID-19炎症级联反应中的作用。抗TNF药物在与COVID-19暂时相关的儿童多系统炎症综合征患者中的作用需要进一步研究。
Coronavirus disease 2019 (COVID-19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID-19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor-alpha (TNF-alpha) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS-CoV-2 polymerase chain reaction was positive. Despite inpatient treatment for COVID-19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid-refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)-6, IL-8, and TNF-alpha, higher than those described in either inflammatory bowel disease or severe COVID-19 alone. The patient was treated with infliximab for TNF-alpha blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID-19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF-alpha, a decrease in IL-6, and IL-8 concentrations. This case supports a role for blockade of TNF-alpha in the treatment of COVID-19 inflammatory cascade. The role of anti-TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID-19 requires further investigation.