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Save the life of a child with acute COVID-19 who developed multisystem inflammatory syndrome with brain damage

Recently, City Children’s Hospital received a case of Tr. G. H, 13 years old, male, lives in Tra Vinh. Taking the medical history recorded for 6 days, N1-4 low-grade fever, cough, sore throat, N5-6 child with high fever, fatigue, poor diet, admitted to local hospital in shock state: lethargy, cool extremities , light pulse 170 times/min, BP 80/60 mmHg, sweating, breathing 50 times/min, lungs are not rales, abdomen is soft, jugular vein is not prominent, rapid test for SARS-CoV-2 is positive. Diagnosing septic shock, sepsis, severe pneumonia, COVID-19 day 6. Differential diagnosis of cardiogenic shock, monitoring myocarditis, acute COVID-19 N6, receiving oxygen therapy, anti-shock fluids with Lactate Ringer 40 ml/kg for 3 hours, infusion of adrenaline vasopressor at 0.1 mcg/kg/min, transferred to Children’s Hospital City. History: No related or previous disease has been recorded. Here, the child was lethargic, the pulse rotated clearly 120 times/minute, the blood pressure was 100/60 mmHg, the intercostal contraction breathing was 36 times/minute, the lungs were rough, and the abdomen was soft. Blood tests showed severe metabolic acidosis, increased blood lactate, increased inflammatory response CRP 41.3 mg/L (normal < 5mg/L, Procalcitonin 75.4 ng/ml (normal < 0.5 ng/). ml), liver enzymes increased AST 1565 units/L, ALT 634 units/L (normal < 40 units/L), the Real Time RT PCR SARS-CoV-2 test was positive.

Children diagnosed with septic shock, sepsis, severe pneumonia, liver damage, COVID-19 N6, receive respiratory support, anti-inflammatory, antiviral, antibiotics, anticoagulation, bicarbonate compensation, adjustment electrolyte. Progression after nearly 2 weeks of treatment, the child’s condition gradually improved, the inflammatory indicators improved, the Real Time RT PCR SARS-CoV-2 test was negative. However, by the 3rd week, the child had fever again, red eyes, red skin, showed signs of movement coordination disorder, unsteadiness, ataxia, headache, inflammatory reaction tests in the blood increased again (VS, CRP, PCT, LDH, Ferritin, etc.), the children had a normal cerebrospinal fluid puncture and had a brain MRI, gHi received bilateral thalamic lesions, cerebellar white matter lesions. Children were diagnosed with multisystem inflammatory syndrome, brain damage, treated with high-dose anti-inflammatory, anticoagulation to prevent embolism. Results after one more week of treatment, the child had no fever, no redness, was alert, eating well, his inflammatory response tests were normal, he was discharged from the hospital for a full course of anti-inflammatory treatment and re-examination by appointment.

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This is a rare case of a child with COVID-19 who had severe liver damage and then developed a multisystem inflammatory syndrome with neurological damage.

Parents should note to bring their children to be vaccinated against COVID-19 according to the program, to prepare carefully for their children before going to get vaccinated as if to let them know the benefits of vaccination, to encourage children to not have to worry much. Just like other common vaccinations, let children wear short-sleeved shirts to easily access the injection site, feed children to avoid hypoglycemia, so bring a bottle of drinking water, milk cartons, and some sweets if possible. Parents follow the child care to avoid letting the children run and jump, naughty causing disorder, the waiting space is cool with entertainment activities, chatting with the children … so that the children are comfortable while waiting for their turn to be vaccinated…

Nuclear magnetic resonance imaging (MRI) of the brain showed damage to the white matter of the cerebellum on both sides, causing motor coordination disorders, staggering, and ataxia.

Doctor of CK2 Nguyen Minh Tien
City Children’s Hospital

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