Therapeutic Plasma Exchange for a Critically Ill Late Preterm Infant with Multisystem Inflammatory Syndrome of Children: A Case Report and Review of the Literature

Abstract

Multisystem inflammatory syndrome of children (MIS-C) is a clinical picture that entered the medical nomenclature after the coronavirus disease 2019 pandemic. Although it primarily affects older children, there have been a limited number of cases reported during the neonatal period. Herein we present a patient, a late preterm infant, with severe MIS-C-related cerebral sinus venous thrombosis who was successfully treated with therapeutic plasma exchange. Practitioners can consider therapeutic plasma exchange as a safe and effective option for the treatment of critically ill MIS-C cases.

Keywords

COVID-19 - MIS-C - newborn - therapeutic plasma exchange

Ethics Approval

Institutional Review Board approval was received from local Ethics Committee of Türkiye Health Sciences University.

Informed Consent

Informed consent was obtained from the parents prior to participation in the study.

Data Availability

All data of the patient are stored in the data recording system of our hospital.

Publication History

Received: 18 January 2024

Accepted: 06 August 2024

Article published online:
29 August 2024

• References

• 1 Deng CX. The global battle against SARS-CoV-2 and COVID-19. Int J Biol Sci 2020; 16 (10) 1676-1677
• 2 Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). CDC Health Alert Network; 2020.
• 3 Melgar M, Lee EH, Miller AD. et al. Council of State and Territorial Epidemiologists/CDC surveillance case definition for multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection - United States. MMWR Recomm Rep 2022; 71 (04) 1-14
• 4 Centers for Disease Control and Prevention (CDC). CSTE. https://ndc.services.cdc.gov/case-definitions/multisystem-inflammatory-syndrome-in-children-mis-c-2023/
• 5 More K, Aiyer S, Goti A. et al. Multisystem inflammatory syndrome in neonates (MIS-N) associated with SARS-CoV2 infection: a case series. Eur J Pediatr 2022; 181 (05) 1883-1898
• 6 Zuccotti G, Calcaterra V, Mannarino S. et al. Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: an Italian single-center experience. Front Pediatr 2023; 10: 1080654
• 7 De Rose DU, Pugnaloni F, Calì M. et al. Multisystem inflammatory syndrome in neonates born to mothers with SARS-CoV-2 infection (MIS-N) and in neonates and infants younger than 6 months with acquired COVID-19 (MIS-C): a systematic review. Viruses 2022; 14 (04) 750
• 8 Jiang L, Tang K, Levin M. et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis 2020; 20 (11) e276-e288
• 9 Mascarenhas D, Goyal M, Haribalakrishna A, Nanavati R, Ish P, Kunal S. Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review. Eur J Pediatr 2023; 182 (05) 2283-2298
• 10 Pawar R, Gavade V, Patil N. et al. Neonatal multisystem inflammatory syndrome (MIS-N) associated with prenatal maternal SARS-CoV-2: a case series. Children (Basel) 2021; 8 (07) 572
• 11 Sözeri B, Çağlayan Ş, Atasayan V. et al. The clinical course and short-term health outcomes of multisystem inflammatory syndrome in children in the single pediatric rheumatology center. Postgrad Med 2021; 133 (08) 994-1000
• 12 Porosnicu TM, Sirbu IO, Oancea C. et al. The impact of therapeutic plasma exchange on inflammatory markers and acute phase reactants in patients with severe SARS-CoV-2 infection. Medicina (Kaunas) 2023; 59 (05) 867
• 13 Ebermeyer T, Hequet O, Berard F. et al. The efficacy of therapeutic plasma exchange in COVID-19 patients on endothelial tightness in vitro is hindered by platelet activation. Front Cardiovasc Med 2023; 10: 1094786
• 14 Durak C, Guney Sahin E, Can YY, Varol F. Retrospective evaluation of therapeutic plasma exchange treatment in a pediatric intensive care unit: single-center experience. Artif Organs 2023; 47 (09) 1464-1471
• 15 Al-Hashami S, Khamis F, Al-Yahyay M. et al. Therapeutic plasma exchange: a potential therapeutic modality for critically ill adults with severe acute respiratory syndrome coronavirus 2 infection. J Clin Apher 2022; 37 (06) 563-572
• 16 Atay G, Hasbal C, Türk M, Erdoğan S, Sözeri B. The role of therapeutic plasma exchange (TPE) in multisystem inflammatory syndrome in children (MIS-C). Children (Basel) 2021; 8 (06) 498
• 17 Katlan B, Kesici S, Karacanoğlu D. et al. Early is superior to late plasma exchange for severe multisystem inflammatory syndrome in children. J Clin Apher 2022; 37 (03) 281-291
• 18 Dakay K, Cooper J, Bloomfield J. et al. Cerebral venous sinus thrombosis in COVID-19 infection: a case series and review of the literature. J Stroke Cerebrovasc Dis 2021; 30 (01) 105434
• 19 Lindan CE, Mankad K, Ram D. et al; ASPNR PECOBIG Collaborator Group. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health 2021; 5 (03) 167-177
• 20 Trapani S, Rubino C, Lasagni D. et al. Thromboembolic complications in children with COVID-19 and MIS-C: a narrative review. Front Pediatr 2022; 10: 944743
• 21 Whitworth H, Sartain SE, Kumar R. et al. Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C. Blood 2021; 138 (02) 190-198
• 22 Davies P, Evans C, Kanthimathinathan HK. et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4 (09) 669-677
• 23 Aguilera-Alonso D, Murias S, Martínez-de-Azagra Garde A. et al; EPICO-AEP Working Group. Prevalence of thrombotic complications in children with SARS-CoV-2. Arch Dis Child 2021; 106 (11) 1129-1132
• 24 Di Profio E, Leone A, Vizzuso S. et al. Longitudinal anthropometry and body composition in children with SARS-CoV-2-associated multisystem inflammatory syndrome. J Pediatr Gastroenterol Nutr 2023; 76 (04) 505-511
• 25 National Institutes of Health (NIH). Treatment considerations for children with MIS-C. Accessed February 29, 2024 at: https://www.covid19treatmentguidelines.nih.gov/management/clinical-management-of-children/hospitalized-children-therapeutic-management-of-mis-c/