Recent studies have revealed a new type of inflammatory syndrome in children, known as Multi-System Inflammatory Syndrome in Children (MIS-C), which has been suspected to be related to COVID-19. However, an extremely rare case report has emerged where a child with MIS-C had a relapse of the syndrome known as Rebound Multi-System Inflammatory Syndrome. This new condition is still not well-understood and there is limited knowledge available regarding its treatment and management. This article aims to shed light on this unique case and provide insights into the potential dangers and implications of this syndrome for children.
A recent scientific paper on the Research Square preprint server details the case of an infant boy experiencing rebound multi-system inflammatory syndrome in children (MIS-C), a rare and severe condition related to COVID-19. The child suffered from two episodes of MIS-C 19 days apart, with the second being more severe and resulting in an aneurysm in the right coronary artery. Fortunately, the physicians were able to treat both episodes of MIS-C with standard therapy protocols. MIS-C is characterized by systemic hyperinflammation, persistent fever, and multi-organ frailty, all related to SARS-CoV-2 infection. Rebound MIS-C is rare, with only two previous cases reported, and in this case, it occurred within four to six weeks of ceasing treatment or during the tapering of drugs.
During the first hospital admission, the boy had a persistent fever, skin rashes, vomiting, and diarrhea, and a reverse transcription-polymerase chain reaction (RT-PCR) test confirmed a COVID-19 diagnosis a month before. An electrocardiogram (ECG) revealed a slightly dilated left ventricle, but the coronary arteries appeared normal. Treatment with methylprednisolone, IVIG, ceftriaxone, and aspirin resolved all MIS-C symptoms except lung sounds. Oral prednisolone therapy fully resolved his MIS-C manifestations, and the patient was discharged. However, 19 days after discharge, the boy required hospitalization again, and an echo revealed an aneurysm in his right coronary artery.
The researchers considered the possibility of a rebound MIS-C, given the boy’s COVID-19 history and previous gastrointestinal symptoms, and ruled out an alternative diagnosis of Kawasaki disease. Treatment with methylprednisolone at the dosage used during the initial treatment, along with antibiotics and oral prednisolone, stabilized the patient within eight days, and he was discharged. During the 12-month follow-up, two ECGs revealed that all echocardiography parameters were normal.
While MIS-C related death rates are ~1.7%, most patients with cardiac issues recover, though coronary artery aneurysms may persist in 20% of patients. In this case, the aneurysm did not persist. MIS-C most frequently impacts the GI, cutaneous, and cardiovascular systems in up to 87%, 73%, and 100% of cases, respectively, but in this case, it involved all three systems. Rebound MIS-C is rare, occurring in only ~0.1% of Kawasaki disease patients, and further study is needed to characterize its pattern and determine the most effective treatment strategies. The case highlights the need for close and long-term monitoring of patients with MIS-C, and future studies may consider more aggressive and prolonged treatment to prevent rebound MIS-C or related complications.
In conclusion, the case report of rebound multi-system inflammatory syndrome in children is a rare but serious complication that healthcare professionals need to be aware of. With further research and understanding of this condition, we can hope to provide better treatment and care for children affected by this syndrome. As parents and caregivers, it is crucial to seek medical attention if your child is experiencing any symptoms of inflammation or fever post-COVID-19 recovery. Let us all work together to ensure the safety and well-being of our children in these unprecedented times.
