14-yr-old boy survives post-covid multisystem inflammatory syndrome in children

The parents of 14-year-old Bratin Dasgupta had no idea that he had been infected by Covid-19 a few months back until he developed a condition as a fallout of the disease. The ailment affected his heart and almost led to multi organ failure.

Bratin, a student of Class IX in Don Bosco, Park Circus, was brought to the emergency of Apollo Gleneagles Hospitals with excessive lethargy, rash in extremities and persistent high grade fever with severe paleness. On evaluation, the child was found to be hypotensive with cardiogenic shock. Initial investigations revealed thrombocytopenia (abnormally low levels of platelets) with raised acute reactions like inflammation in the body (CRP, PCT). Further clinical findings revealed that he was suffering from Multisystem inflammatory syndrome in children (MIS-C) that often manifests two or three months after contracting Covid.

Experienced paediatricians at Apollo were awake to the possibility of Bratin having developed MIS-C and sent his blood for an iGg test, which came positive. This meant he had antibodies against Covid-19 in his blood, which in turn meant that he had been Covid-19 positive at some stage without anyone in his family realizing.

“Identifying cardiogenic shock due to MIS-C as fast as possible is crucial for recovery or else it can be life threatening. Once identified, the condition can be easily managed with steroids,” said Dr. Kaustabh Choudhuri, consultant paediatrician at Apollo, who treated the child.

Bratin had developed fever from March 3, which would not come down with the administration of paracetamol. Tests for malaria, typhoid and dengue had come negative. When his platelet count, too, fell to 58,000 his parents got him admitted to Apollo on February 16.

Once admitted, other inflammatory parameters were examined in view of MIS-C and turned out to be highly positive. Echocardiography showed severe myocardial dysfunction with ejection fraction of only 28% (normally it is 60 per cent) and revealed severe systolic dysfunction, dilated Inferior vena cava (IVC is a large blood vessel responsible for transporting deoxygenated blood from the lower extremities and abdomen back to the right atrium of the heart). The child also showed acute Covid psychosis in form of delusion and hallucinations.

With Intravenous immunoglobulin and steroid the child’s condition improved and the Echo done the next day showed progress in treatment.  Fever spikes gradually decreased with improvement in laboratory parameters and child’s psychological status also got better in due course. This case highlights post Covid severe myocardial dysfunction as MIS-C with Covid psychosis. The outcome is poor if not diagnosed promptly with proper treatment support because most of the time, other common bacterial infections thought as possibility results in loss of valuable time and delay the diagnosis.  Recently similar cases reported from USA, UK with detrimental outcome.

According to paediatricians, it is important for parents as well as doctors in general to be alert to MIS-C as a possible cause of unrelenting fever which can help in early diagnosis.

“I had no idea when my son had Covid. No one in his immediate contact did either. Also, we did not know that Covid in children could lead to such a serious condition later. But Dr. Kaustabh explained everything to us treated my son back to good health very fast,” said Brotin’s father Bireswar Dasgupta.

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