PMC8377535_01
(A) non-itchy macular erythematous rash on the soles of the feet and trunk of the first patient; (B) non-itchy erythematosus rash on palms of the hands, on soles of the feet, on trunk and limbs of the second patient.
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PMC8377535_02_fped-09-676934-g0001.jpg
F1
A previously healthy 12-year-old boy was admitted to the Pediatric Department with a 2-day history of fever, myalgia, and non-itchy erythematosus rash on palms of the hands, on soles of the feet, on trunk, and on limbs (Figure 1B).
(A) Timeline of tropinin and BNP levels and therapy with IVIG and steroids in case 1. (B) Timeline of troponin, BNP levels, PR interval and therapy with IVIG and steroids in case 2. The number of days refers to the onset of the fever. BNP, brain natriuretic peptide; IVIG, intravenous immunoglobulins; IV, intravenous; NV, normal values.
fped-09-676934-g0002.jpg
PMC8377535_02_fped-09-676934-g0002.jpg
F2
I (321 pg/ml) and BNP (273 pg/ml) was documented (Figure 2B). Increases in ferritin (521 ng/ml), IL-6 (70.7 pg/ml), triglyceride (171 mg/dl, normal range 0-150), and liver enzyme (AST 156 U/l, normal range 5-34; ALT 175 U/l, normal range 0-55) values were also shown. Defervescence and improved clinical condition were documented, but 8 days after fever onset the echocardiography found worsening ejection fraction (53%) and moderate mitral regurgitation in association with increased BNP (405 pg/ml, Figure 2B) and oliguria. During the hospitalization, troponin I and BNP values showed progressive decrease (Figure 2B).
(A) 2-D Color-Doppler echocardiography of the first patient in the acute phase: left panel shows the apical 4 chambers view with color flow Doppler, showing a moderate mitral regurgitation; right panel shows the continuous wave Doppler of the mitral regurgitant jet. (B) 2-D Color-Doppler echocardiography of the same patient 1 month after: left panel shows an apical 4 chambers view with color flow Doppler and right panel shows the continuous wave Doppler of the minimal mitral regurgitation.
fped-09-676934-g0003.jpg
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F3
However, 5 days after the fever onset the echocardiogram showed a "mild tricuspid regurgitation and moderate mitral regurgitation" (Figure 3A) and the ECG found a QT prolongation, equal to 492 ms (Figure 4A). At follow-up, ECG was normal and the echocardiogram 30 days after the onset of the syndrome showed normal ventricular function and the resolution of mitral regurgitation (Figure 3B).
(A) 12-lead ECG of the first patient 5 days after fever onset showed a mild ST-segment depression and a deeper T-wave inversion compared with previous ECG in the anterior precordial leads; (B) 12-lead ECG of the second patient 8 days after fever onset showed a sinus bradycardia (HR 48 beats per minute) with a first-degree atrioventricular block (PR = 216ms).
fped-09-676934-g0004.jpg
PMC8377535_02_fped-09-676934-g0004.jpg
F4
In addition, flat and inverted diffusely T waves and bradycardia (heart rate 40 beats per minute at night, 55 beats per minute during the day) with PR interval prolongation (from 188 ms at the onset, PR reached a maximum of 232 ms 8 days after the onset) and a first-degree atrioventricular block (AVB) appeared (Figure 4B).
PMC8377535_02
(A) non-itchy macular erythematous rash on the soles of the feet and trunk of the first patient; (B) non-itchy erythematosus rash on palms of the hands, on soles of the feet, on trunk and limbs of the second patient.
fped-09-676934-g0001.jpg
PMC8377535_02_fped-09-676934-g0001.jpg
F1
A previously healthy 12-year-old boy was admitted to the Pediatric Department with a 2-day history of fever, myalgia, and non-itchy erythematosus rash on palms of the hands, on soles of the feet, on trunk, and on limbs (Figure 1B).
(A) Timeline of tropinin and BNP levels and therapy with IVIG and steroids in case 1. (B) Timeline of troponin, BNP levels, PR interval and therapy with IVIG and steroids in case 2. The number of days refers to the onset of the fever. BNP, brain natriuretic peptide; IVIG, intravenous immunoglobulins; IV, intravenous; NV, normal values.
fped-09-676934-g0002.jpg
PMC8377535_02_fped-09-676934-g0002.jpg
F2
I (321 pg/ml) and BNP (273 pg/ml) was documented (Figure 2B). Increases in ferritin (521 ng/ml), IL-6 (70.7 pg/ml), triglyceride (171 mg/dl, normal range 0-150), and liver enzyme (AST 156 U/l, normal range 5-34; ALT 175 U/l, normal range 0-55) values were also shown. Defervescence and improved clinical condition were documented, but 8 days after fever onset the echocardiography found worsening ejection fraction (53%) and moderate mitral regurgitation in association with increased BNP (405 pg/ml, Figure 2B) and oliguria. During the hospitalization, troponin I and BNP values showed progressive decrease (Figure 2B).
(A) 12-lead ECG of the first patient 5 days after fever onset showed a mild ST-segment depression and a deeper T-wave inversion compared with previous ECG in the anterior precordial leads; (B) 12-lead ECG of the second patient 8 days after fever onset showed a sinus bradycardia (HR 48 beats per minute) with a first-degree atrioventricular block (PR = 216ms).
fped-09-676934-g0004.jpg
PMC8377535_02_fped-09-676934-g0004.jpg
F4
In addition, flat and inverted diffusely T waves and bradycardia (heart rate 40 beats per minute at night, 55 beats per minute during the day) with PR interval prolongation (from 188 ms at the onset, PR reached a maximum of 232 ms 8 days after the onset) and a first-degree atrioventricular block (AVB) appeared (Figure 4B).