PMC8459926_01
Clinical and treatment parameters of the patient during the 1st month after hospital admission. (A-H) show the time course of different laboratory parameters during the first 30 days following hospital admission. (I) displays a timeline of the different clinical parameters and specific therapy during the first 30 days.
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Laboratory tests showed elevated C-reactive protein (CRP; 105.9 mg/l, reference range <5 mg/l) as well as interleukin 6 serum levels (IL-6; 128 pg/ml, reference range <7 pg/ml), but only modestly elevated procalcitonin (PCT; 0.12 ng/ml, reference range < 0.05 ng/ml) (Figure 1). Subsequently, on day 4 after hospital admission, liver and renal failure and massive systemic inflammatory response became evident (Figure 1). Figure 1). For this reason, a percutaneous ventricular assist device (Impella , Abiomed, Danvers, NJ, United Within just a few hours after endotracheal intubation, additional venoarterial extracorporeal membrane oxygenation (V-A ECMO) support was required, because of worsening hypoperfusion and severe end-organ failure (Figure 1). Following interdisciplinary discussion (pediatrics, rheumatology, cardiology, and infectious disease), Multisystem Inflammatory Syndrome in children (MIS-C) following preceding SARS-CoV-2 infection was diagnosed and immunosuppressive therapy including high-dose intravenous immunoglobulin (IVIG), dexamethasone and IL-1-blockade (anakinra) was initiated (Figure 1). Clinical and laboratory parameters improved within 3 days and 1 day, respectively (Figure 1).
Histopathology and immunohistochemistry of the patient's endomyocardial biopsy. Serial tissue sections of paraffin-embedded endomyocardial biopsies reveal perivascular fibrosis in absence of myocyte necrosis [Masson Trichrome (A) and HE (B) stainings, see circle] and severe infiltration of CD68+ macrophages (C) and CD3+ T cells (D) primarily around intracardiac small vessels (see circle, magnification x200). HE, hematoxylin-eosin; CD, cluster of differentiation.
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Masson Trichrome and HE stainings further demonstrated the presence of perivascular fibrosis in serial tissue sections, but no myocyte necrosis (Figures 2A-D, see circle).