1 - Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Unidade de Cuidados Intensivos Pediátricos, Área de Pediatria, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
3 - Unidade de Infecciologia Pediátrica, Área de Pediatria, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Publicação no Journal of Paediatrics and Child Health, 2021
Resumo:
Since April 2020, paediatric intensive care societies resonated alerts regarding the emergence of a multisystem inflammatory syndrome in children (MIS-c) associated with COVID-19. The World Health Organization produced a preliminary case definition to help standardize and define MIS-c. Clinical criteria included fever for more than 3 days and two of the following: rash or bilateral non-purulent conjunctivitis or mucocutaneous inflammation signs, hypotension or shock, features of cardiac involvement, coagulopathy and acute gastrointestinal problems. Laboratory criteria included elevated inflammatory markers and the exclusion of otheridentifiable microbial causes. Inclusion criteria were the evidence of COVID-19 or contact with patients with COVID-19. Progression to warm, vasoplegic shock, refractory to volume resuscitation, and demanding haemodynamic support were seen in several cases. In addition to the supportive care, there were recommendations for anti-inflammatory strategies including intravenous immunoglobulin (IVIG), steroids and immunomodulators. We report the first Portuguese case of an adolescent with MIS-c presenting with vasoplegic shock and cardiac injury, with the need for respiratory and cardiovascular support.
Palavras Chave: cardiac injury, intensive care, MIS-c, vasoplegic shock.