Doctors treating coronavirus infection have cautioned that parents and pediatricians should be vigilant about a rare hyperinflammatory syndrome as a post Covid-19 complication in children, as early recognition and treatment of the condition can save lives.
A seven-year old boy, who was diagnosed with the hyperinflammatory syndrome, was admitted to the paediatric intensive care unit with complaints of fever, pain in abdomen and vomiting. The boy is the son of a Pune Municipal Corporation employee. His family members had tested positive for Covid-19 in July, after which they recovered.
“The child had persistent symptoms and we suspected diseases like dengue and septic shock that have similar features,” Dr Jitendra Oswal, deputy medical director of Bharati Hospital, told The Indian Express.
On August 10, when the child was hospitalised, his condition was critical as he had a high pulse rate (142/min), high respiratory rate (26/min) and low blood pressure.
“Our initial diagnosis was hyperinflammatory syndrome, a post-Covid-19 complication. He was administered saline,oxygen and various injections to increase pumping of heart and normalise the blood pressure,” said Dr Bhakti Sarangi, pediatric intensivist.
However, doctors said the child’s inflammatory markers, neutrophils of white blood cells, cardiac enzyme and coagulation parameters were elevated. He was treated with steroid injection on the second day of admission. His breathing deteriorated further, which required a non-invasive ventilator. His CT scan revealed dilated intestines, enlarged liver and spleen. His heart’s left coronary artery was dilated. “Thus, he had heart, lungs, abdomen and liver injury, suggesting multi-organ involvement,” said Dr Oswal.
“On the third day since admission, he was treated with injection immunoglobulin (IVIG). Even after this, his condition did not improve. At this point, an inflammatory substance called interleukin-6 (IL-6) level was documented to be extremely high in blood. He was then given the injection Tocilizumab (which blocks IL-6 receptors and stops inflammation). The child responded dramatically, with the disappearance of fever and abdominal pain in 12 hours. Also, in the next 24-36 hours, we could taper and stop the medications and oxygen. He was discharged after 11 days in the hospital,” he said.
Dr Oswal said he had treated eight such cases and was expecting more such cases in the coming weeks as Covid-19 cases are rapidly rising. “We have documented eight such cases that will be published in a journal soon,” he added.
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