Avoid common mistakes on your manuscript.
To the Editor: Initially, COVID-19–infected children were considered spared from life-threatening complications but continuance of the pandemic exposed diverse presentations of multiple post-COVID complications like MISC [1]. We report a previously healthy, vitally stable 2-y-old girl child who developed sudden onset weakness of right upper and lower limb. An urgent MRI of the brain revealed multiple fresh nonhemorrhagic infarcts associated with luminal irregularities in the left middle cerebral artery bifurcation. 2D-ECHO as part of the stroke workup revealed moderate left ventricular dysfunction with an ejection fraction of 30%–35%. Considering the pandemic, COVID-19 antibodies along with inflammatory markers, D-dimer, and NT proBNP levels were sent which confirmed our suspicion of a post-COVID hyperinflammatory response. Consistent with the MIS-C guidelines, a short course of high-dose steroids (methylprednisolone) with injection enoxaparin were prescribed. Diuretics furosemide and spironolactone were started at doses of 1 mg/kg/d along with aspirin at 3 mg/kg/d for anticoagulation. She remained active, playful with improved limb movements following physiotherapy. On sequential echocardiography at 6 mo, a complete normalization of cardiac function was noted. Repeat MRI at half-yearly follow-up exhibited previous infarct sequalae as minimal gliosis with no new additional changes ruling out previous varicella infection as the cause. Cumulative data highlight the appearance of manifestations of post-COVID syndromes as an evolving condition with frequently changing guidelines [2]. We want clinicians to suspect post-COVID syndrome in children presenting with new-onset multisystemic symptoms with positive inflammatory markers especially in the complete absence of fever.
References
Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20:e276–88.
Tiwari L, Shekhar S, Bansal A, Kumar S. COVID-19 associated arterial ischaemic stroke and multisystem inflammatory syndrome in children: a case report. Lancet Child Adolesc Health. 2021;5:88–90.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics Approval
Taken.
Consent to Participate and Publication
Due verbal and written informed consent was taken from both parents.
Conflict of Interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wadhawan, P., Chavan, B. & Patil, S. Stroke with Myocarditis: A Different Post-COVID Syndrome. Indian J Pediatr 89, 416 (2022). https://doi.org/10.1007/s12098-021-04028-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-021-04028-5