Thrombotic Events in MIS-C Patients: A Single Case Report and Literature Review

Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolis...

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Published in:	Children (Basel) Vol. 10; no. 4; p. 618
Main Authors:	Maniscalco, Valerio, Niccolai, Rachele, Marrani, Edoardo, Maccora, Ilaria, Bertini, Federico, Pagnini, Ilaria, Simonini, Gabriele, Lasagni, Donatella, Trapani, Sandra, Mastrolia, Maria Vincenza
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 25.03.2023 MDPI
Subjects:	Anticoagulants Apixaban Blood clot Care and treatment Case Report Case reports Coronaviruses COVID-19 disability heparin Literature reviews Medical research Medicine, Experimental MIS-C Multisystem inflammatory syndrome in children Pediatrics prophylaxis Pulmonary embolism Risk factors Thrombosis Veins & arteries heparin MIS-C thrombosis prophylaxis disability
ISSN:	2227-9067, 2227-9067
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Abstract	Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolism that was successfully treated with heparin. A literature review of previous TEs in MIS-C patients was conducted (60 MIS-C cases from 37 studies). At least one risk factor for thrombosis was observed in 91.7% of patients. The most frequently observed risk factors were pediatric intensive care unit hospitalization (61.7%), central venous catheter (36.7%), age >12 years (36.7%), left ventricular ejection fraction <35% (28.3%), D-dimer >5 times the upper limit of normal values (71.9%), mechanical ventilation (23.3%), obesity (23.3%), and extracorporeal membrane oxygenation (15%). TEs may concurrently affect multiple vessels, including both arterial and venous. Arterial thrombosis was more frequent, mainly affecting the cerebral and pulmonary vascular systems. Despite antithrombotic prophylaxis, 40% of MIS-C patients developed TEs. Over one-third of patients presented persistent focal neurological signs, and ten patients died, half of whom died because of TEs. TEs are severe and life-threatening complications of MIS-C. In case with thrombosis risk factors, appropriate thromboprophylaxis should be promptly administered. Despite proper prophylactic therapy, TEs may occur, leading in some cases to permanent disability or death.
AbstractList	Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolism that was successfully treated with heparin. A literature review of previous TEs in MIS-C patients was conducted (60 MIS-C cases from 37 studies). At least one risk factor for thrombosis was observed in 91.7% of patients. The most frequently observed risk factors were pediatric intensive care unit hospitalization (61.7%), central venous catheter (36.7%), age >12 years (36.7%), left ventricular ejection fraction <35% (28.3%), D-dimer >5 times the upper limit of normal values (71.9%), mechanical ventilation (23.3%), obesity (23.3%), and extracorporeal membrane oxygenation (15%). TEs may concurrently affect multiple vessels, including both arterial and venous. Arterial thrombosis was more frequent, mainly affecting the cerebral and pulmonary vascular systems. Despite antithrombotic prophylaxis, 40% of MIS-C patients developed TEs. Over one-third of patients presented persistent focal neurological signs, and ten patients died, half of whom died because of TEs. TEs are severe and life-threatening complications of MIS-C. In case with thrombosis risk factors, appropriate thromboprophylaxis should be promptly administered. Despite proper prophylactic therapy, TEs may occur, leading in some cases to permanent disability or death.Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolism that was successfully treated with heparin. A literature review of previous TEs in MIS-C patients was conducted (60 MIS-C cases from 37 studies). At least one risk factor for thrombosis was observed in 91.7% of patients. The most frequently observed risk factors were pediatric intensive care unit hospitalization (61.7%), central venous catheter (36.7%), age >12 years (36.7%), left ventricular ejection fraction <35% (28.3%), D-dimer >5 times the upper limit of normal values (71.9%), mechanical ventilation (23.3%), obesity (23.3%), and extracorporeal membrane oxygenation (15%). TEs may concurrently affect multiple vessels, including both arterial and venous. Arterial thrombosis was more frequent, mainly affecting the cerebral and pulmonary vascular systems. Despite antithrombotic prophylaxis, 40% of MIS-C patients developed TEs. Over one-third of patients presented persistent focal neurological signs, and ten patients died, half of whom died because of TEs. TEs are severe and life-threatening complications of MIS-C. In case with thrombosis risk factors, appropriate thromboprophylaxis should be promptly administered. Despite proper prophylactic therapy, TEs may occur, leading in some cases to permanent disability or death. Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolism that was successfully treated with heparin. A literature review of previous TEs in MIS-C patients was conducted (60 MIS-C cases from 37 studies). At least one risk factor for thrombosis was observed in 91.7% of patients. The most frequently observed risk factors were pediatric intensive care unit hospitalization (61.7%), central venous catheter (36.7%), age >12 years (36.7%), left ventricular ejection fraction <35% (28.3%), D-dimer >5 times the upper limit of normal values (71.9%), mechanical ventilation (23.3%), obesity (23.3%), and extracorporeal membrane oxygenation (15%). TEs may concurrently affect multiple vessels, including both arterial and venous. Arterial thrombosis was more frequent, mainly affecting the cerebral and pulmonary vascular systems. Despite antithrombotic prophylaxis, 40% of MIS-C patients developed TEs. Over one-third of patients presented persistent focal neurological signs, and ten patients died, half of whom died because of TEs. TEs are severe and life-threatening complications of MIS-C. In case with thrombosis risk factors, appropriate thromboprophylaxis should be promptly administered. Despite proper prophylactic therapy, TEs may occur, leading in some cases to permanent disability or death.
Audience	Academic
Author	Lasagni, Donatella Simonini, Gabriele Mastrolia, Maria Vincenza Maccora, Ilaria Trapani, Sandra Marrani, Edoardo Niccolai, Rachele Bertini, Federico Pagnini, Ilaria Maniscalco, Valerio
AuthorAffiliation	4 Radiology Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy 5 Pediatric Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy 3 NEUROFARBA Department, University of Florence, 50139 Firenze, Italy 1 Department of Health Sciences, University of Florence, 50134 Firenze, Italy 2 Rheumatology Unit, ERN-ReCONNET Center, Meyer Children Hospital IRCCS, 50139 Firenze, Italy
AuthorAffiliation_xml	– name: 2 Rheumatology Unit, ERN-ReCONNET Center, Meyer Children Hospital IRCCS, 50139 Firenze, Italy – name: 4 Radiology Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy – name: 5 Pediatric Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy – name: 1 Department of Health Sciences, University of Florence, 50134 Firenze, Italy – name: 3 NEUROFARBA Department, University of Florence, 50139 Firenze, Italy
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SubjectTerms	Anticoagulants Apixaban Blood clot Care and treatment Case Report Case reports Coronaviruses COVID-19 disability heparin Literature reviews Medical research Medicine, Experimental MIS-C Multisystem inflammatory syndrome in children Pediatrics prophylaxis Pulmonary embolism Risk factors Thrombosis Veins & arteries
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Title	Thrombotic Events in MIS-C Patients: A Single Case Report and Literature Review
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