Hyperinflammation in Two Severe Acute Respiratory Syndrome Coronavirus 2-Infected Adolescents Successfully Treated With the Interleukin-1 Inhibitor Anakinra and Glucocorticoids

Frontiers in Pediatrics

article

Francesca I. Calò Carducci¹  Andrea Campana¹  Maria Antonietta De Ioris¹  Chiara Agrati²  Rita Carsetti³  Daniela Perrotta⁴  Patrizia D'Argenio¹  Fabrizio De Benedetti⁵  Stefania Notari²  Paolo Rossi¹ 

[1] Academic Department of Pediatrics, Bambino Gesù Children's Hospital;Cellular Immunology Laboratory, IRCCS National Institute for Infectious Diseases “L. Spallanzani”;Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital;Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital;Division of Rheumatology, Bambino Gesù Children's Hospital

关键词: pediatric;    coronavirus disease 2019;    MIS-C;    PIMS-TS;    cytokine storm;    anti-inflammatory treatment;    SARS-CoV-2;    COVID-19;   

DOI  :  10.3389/fped.2020.576912

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: In severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) critically ill adults, hyperinflammation plays a key role in disease progression. The clinical manifestations of SARS-CoV-2 infection among children are much less severe compared with adult patients and usually associated with a good prognosis. However, hyperinflammation in SARS-CoV-2-infected pediatric patients has been described as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or as Kawasaki-like disease but is still little known, and optimal management has to be defined. The World Health Organization (WHO) on the 15th of May 2020 has developed a preliminary case definition for multisystem inflammatory disorder in children and adolescents with coronavirus disease 2019 (COVID-19) and stated for an urgent need to collect data on this condition. Here, we report two adolescent patients affected by COVID-19 presenting with multisystem inflammatory disorder, 3–4 weeks after the first symptoms of SARS-CoV-2 infection, treated with the interleukin-1 receptor antagonist anakinra and glucocorticoids with good clinical response. Cases: We report two patients chronically ill appearing, with high fever, severe gastrointestinal involvement, and increased biomarkers of inflammation onset 3–4 weeks after paucisymptomatic SARS-CoV-2 infection. They had no lung involvement, but abdominal ultrasound and CT scan showed thickening of the bowel wall. SARS-CoV-2 PCR was positive on ileum biopsy in both patients, whereas it was negative on other common sampled sites. They have been admitted to the pediatric intensive care unit and have been treated with a combination of anakinra 6–8 mg/kg/day i.v. and a standard dose of methylprednisolone 2 mg/kg/day in addition to lopinavir/ritonavir 400 mg q12h and low molecular weight heparin 100 UI/kg q12h with good clinical response.

【 授权许可】

CC BY