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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

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.

Details

Title
Thrombotic Events in MIS-C Patients: A Single Case Report and Literature Review
Author
Maniscalco, Valerio 1   VIAFID ORCID Logo  ; Niccolai, Rachele 1   VIAFID ORCID Logo  ; Marrani, Edoardo 2 ; Maccora, Ilaria 3   VIAFID ORCID Logo  ; Bertini, Federico 4 ; Pagnini, Ilaria 2   VIAFID ORCID Logo  ; Simonini, Gabriele 3   VIAFID ORCID Logo  ; Lasagni, Donatella 5 ; Trapani, Sandra 6 ; Mastrolia, Maria Vincenza 2   VIAFID ORCID Logo 

 Department of Health Sciences, University of Florence, 50134 Firenze, Italy 
 Rheumatology Unit, ERN-ReCONNET Center, Meyer Children Hospital IRCCS, 50139 Firenze, Italy 
 Rheumatology Unit, ERN-ReCONNET Center, Meyer Children Hospital IRCCS, 50139 Firenze, Italy; NEUROFARBA Department, University of Florence, 50139 Firenze, Italy 
 Radiology Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy 
 Pediatric Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy 
 Department of Health Sciences, University of Florence, 50134 Firenze, Italy; Pediatric Unit, Meyer Children Hospital IRCCS, 50139 Firenze, Italy 
First page
618
Publication year
2023
Publication date
2023
Publisher
MDPI AG
e-ISSN
22279067
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2806487310
Copyright
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.