COVID-19-Associated Multisystem Inflammatory Syndrome in a Neonate with Atypical Coronary Artery Involvement

Simonetta Costa; Angelica B. Delogu; Anthea Bottoni; Velia Purcaro; Vito D'Andrea; Angela Paladini; Sara Muto; Riccardo Marano; Giancarlo Savino; Aurelio Secinaro; Fabrizio De Benedetti; Rita Carsetti; Eva Piano Mortari; Teresa Spanu; Giovanni Vento

doi:10.1055/a-1733-4163

American Journal of Perinatology, Table of Contents

Am J Perinatol 2022; 29(14): 1514-1518
DOI: 10.1055/a-1733-4163

Short Communication

COVID-19-Associated Multisystem Inflammatory Syndrome in a Neonate with Atypical Coronary Artery Involvement

Simonetta Costa‡^*

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Angelica B. Delogu‡^*

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

²Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy

,

Anthea Bottoni

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Velia Purcaro

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Vito D'Andrea

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Angela Paladini

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Sara Muto

²Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy

,

Riccardo Marano

³Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

⁴Dipartimento di Scienze radiologiche ed ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy

,

Giancarlo Savino

³Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Aurelio Secinaro

⁵Department of Imaging, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Fabrizio De Benedetti

⁶Division of Rheumatology and Laboratory of Immuno-Rheumatology, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Rita Carsetti

⁷Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

⁸Microbiology and Diagnostic Immunology Unit, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Eva Piano Mortari

⁷Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

,

Teresa Spanu

⁹Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

¹⁰Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy

,

Giovanni Vento

¹Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Rome, Italy

²Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy

› Author Affiliations

Abstract

Objective The study aimed to report a novel coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C) in a neonate found to have an atypical diffuse thickening in coronary artery walls whose diagnosis required a multi-imaging approach.

Study Design A neonate presented at birth with multiple organ involvement and coronary artery anomalies. A diagnosis of MIS-C associated with COVID-19 was supported by maternal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy, and by the presence of both immunoglobulin (Ig)-G against SARS-CoV-2 and spike-specific memory B-cells response in the neonatal blood. Other plausible causes of the multiple organ involvement were excluded.

Result At admission, a severe coronary artery dilatation was identified on echocardiography, supporting the diagnosis of the MIS-C Kawasaki-like disease; however, coronary artery internal diameters were found to be normal using cardiac computed tomography angiography. At discharge, comparing the two imaging techniques each other, the correct diagnosis resulted to be an abnormal thickening in coronary arterial walls. These findings suggest that the inflammatory process affecting the coronary arterial wall in MIS-C could result not only in typical coronary artery lesions such as dilatation of the lumen or aneurysms development but also in abnormal thickening of the coronary artery wall.

Conclusion Our case provides an alert for pediatric cardiologists about the complexity to assess coronary artery involvement in MIS-C and raises the question that whether an abnormal vascular remodeling, with normal inner diameters, is to be considered like coronary artery dilatation for risk stratification.

Key Points

COVID-19 associated MIS-C can present in neonates with multiple organ involvement.
Coronary artery assessment in neonatal MIS-C could be complex, and a multi-imaging approach could be required.
Beside the typical coronary artery lesions, such as dilatation of the lumen or aneurysms, also abnormal thickening of the coronary artery wall can occur.

Keywords

COVID-19 - multisystem inflammatory syndrome in children - neonate - prenatal exposure to SARS-CoV-2 - neonatal MIS-C - coronary artery involvement

Full Text

References

References
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