SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome
SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome
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DOI：
10.1016/s2352-4642(20)30257-1
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发表时间：
2020-10-01
影响因子：
36.4
通讯作者：
Caldini, Elia Garcia
中科院分区：
文献类型：
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作者：
Dolhnikoff, Marisa;Ferranti, Juliana Ferreira;Caldini, Elia Garcia
我们报告了一名患有与COVID-19相关的儿童多系统炎症综合征（MIS-C）的11岁儿童的病例，该儿童出现心力衰竭，并在入院治疗1天后死亡。该患者是一名健康的非洲裔女性，因心血管休克和持续发热被送入儿科重症监护室（ICU）。她最初的症状是发热7天，吞咽痛，肌痛和腹痛。在入住ICU时，患者出现呼吸窘迫，包括呼吸急促（呼吸频率70次/min）和缺氧，以及充血性心力衰竭体征，包括颈静脉扩张、肺底爆裂音、肝脏移位、低血压（血压80/36 mm Hg）、心动过速（134次/min [bpm]）和四肢冰冷伴丝状脉搏。体格检查时出现非渗出性结膜炎和嘴唇开裂。患者立即插管，并开始头孢曲松和阿奇霉素抗生素治疗。在患者被转移到儿科ICU之前，在急诊室开始外周肾上腺素治疗。即时超声心动图显示弥漫性左心室运动功能减退，无节段性室壁运动异常。在胸骨旁短轴视图中，在二尖瓣乳头肌水平，采用M型Teichholz方法估计左心室射血分数;观察到严重心肌功能障碍，左心室射血分数降低（31%），下腔静脉无呼吸道阻塞。患者接受呋塞米治疗，并建立了中心线和有创动脉监测。最初的放射学检查显示心脏区域扩大和双侧肺阴影（附录p1）。胸部CT显示多发性磨玻璃样肺阴影伴小叶间隔增厚和稀疏的双侧实变灶，主要位于下叶的外周和后部区域（附录p 1）。
We report the case of an 11-year-old child with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 who developed cardiac failure and died after 1 day of admission to hospital for treatment. An otherwise healthy female of African descent, the patient was admitted to the paediatric intensive care unit (ICU) with cardiovascular shock and persistent fever. Her initial symptoms were fever for 7 days, odynophagia, myalgia, and abdominal pain. On admission to the ICU, the patient presented with respiratory distress, comprising tachypnoea (respiratory rate 70 breaths per min) and hypoxia, and signs of congestive heart failure, including jugular vein distention, crackles at the base of the lungs, displaced liver, hypotension (blood pressure 80/36 mm Hg), tachycardia (134 beats per min [bpm]), and cold extremities with filiform pulses. Non-exudative conjunctivitis and cracked lips were present on physical examination. The patient was promptly intubated and antibiotic treatment was started with ceftriaxone and azithromycin. Peripheral epinephrine was initiated in the emergency room before the patient was moved to paediatric ICU.A point-of-care echocardiogram showed diffuse left-ventricular hypokinesia with no segmental wall motion abnormalities. Left-ventricular ejection fraction was estimated with the M-mode Teichholz method in the parasternal short axis view, at the level of the papillary muscles of the mitral valve; substantial myocardial dysfunction was noted, with decreased left-ventricular ejection fraction (31%) and no respiratory collapsibility of the inferior vena cava. The patient received furosemide, and central line and invasive arterial monitoring were established. Initial radiography showed an enlarged cardiac area and bilateral lung opacities (appendix p 1). Chest CT showed multiple ground-glass pulmonary opacities associated with thickening of interlobular septa and sparse bilateral foci of consolidation, predominantly in the peripheral and posterior areas of lower lobes (appendix p 1).