Volume 28, Number 5—May 2022
Dispatch
Multisystem Inflammatory Syndrome in Children after SARS-CoV-2 Vaccination
Eisha Jain, Jeffrey R. Donowitz, Elizabeth Aarons, Beth C. Marshall, and Michael P. Miller
Table
Data for 2 adolescent patients experiencing multisystem inflammatory syndrome after initial dose of BNT162b2 vaccination against severe acute respiratory syndrome coronavirus 2, United States*
| Data | Patient 1 | Patient 2 |
|---|---|---|
| Age, y/sex |
15/F |
17/F |
| Underlying conditions |
Asthma, seasonal allergies |
None |
| Time since BNT162b2 dose, d |
6 |
7 |
| Initial symptoms |
102°F fever, headache, nonbilious emesis, myalgias, chest pain, diffuse blanching rash |
103.1°F fever, headache, abdominal tenderness, fatigue, myalgias, and costovertebral angle tenderness |
| Initial vital signs |
Blood pressure 115/56 mm Hg, pulse 105 beats/min, temperature 100.4°F, respiratory rate 20 breaths/min, oxygen saturation 100%, weight 60.8 kg |
Blood pressure 104/59 mm Hg, pulse 124 beats/min, temperature 103.1°F, respiratory rate 18 breaths/min, oxygen saturation 99%, weight 58 kg |
| Laboratory test results (reference range) | ||
| Leukocytes, K/μL (4.2–9.4) | 17 | 21.1 |
| % PMNs (39–74) | 91 | 90 |
| % Lymphocytes (18–50) | 3 | 5 |
| CRP, mg/dL (0–0.60) | 15.1 | 36.7 |
| ESR, mm/H (0–15) | 13 | 83 |
| LDH, U/, sL (130–230) | 176 | 326 |
| Fibrinogen, mg/dL (200–475) | 516 | >800 |
| Prothrombin time, s (9–11.1) | 11.4 | 11.3 |
| BNP, pg/mL (<125) | 169 | 560 |
| Troponin, ng/mL (<0.05) | <0.05 | 0.18 |
| D-dimer, mg/L (0–0.65) | 2.84 | 2.58 |
| Creatinine, mg/dL (0.3–1.10) | 0.92 | 1.39 |
| AST U/L (15–37) | 16 | 71 |
| ALT, U/L (12–78) | 22 | 73 |
| Alkaline phosphate, U/L (40–120) |
73 |
258 |
| Additional work-up | ||
| Urinalysis | Trace protein, large blood, moderate leukocyte esterase, 10–20 leukocytes, 1+ bacteria | 100 mg/dL of protein, moderate blood, moderate leukocyte esterase, 10–20 leukocytes, 5–10 red blood cells, no bacteria |
| Urine culture | Not performed | 10,000 CFUs Escherichia coli |
| Blood culture | Not performed | Negative |
| Chest radiograph | No abnormal findings | No abnormal findings |
| Chest CT | No abnormal findings | Not performed |
| Electrocardiogram | No abnormal findings | Sinus tachycardia, nonspecific T-wave abnormalities |
| Echocardiogram | No abnormal findings | No abnormal findings |
| Abdomen/pelvis CT |
Not performed |
Diffuse left renal enlargement, possible polycystic ovaries |
| COVID-19 labs | ||
| Nasopharyngeal RT-PCR | Negative | Negative |
| Spike antibody | Negative | Positive |
| Nucleocapsid antibody |
Positive |
Not performed |
| PICU admission |
Yes |
No |
| Treatment |
2 g/kg IVIG |
2 g/kg IVIG for 1 d, 30 mg IV methylprednisolone 2×/d for 3 d to continue at home orally for 2 d then 2–3 wk steroid taper, 325 mg aspirin reduced to 81 mg on day 3, cefdinir 7 d course |
| Length of hospital stay | 1 d | 3 d |
*BNT162b2, Pfizer-BioNTech (https://www.pfizer.com). ALT, alanine transaminase; AST, aspartate transaminase; BNP, brain natriuretic peptide; COVID-19, coronavirus disease; CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; IVIG, intravenous immune globulin; LDH, lactate dehydrogenase; PICU, pediatric intensive care unit; PMN, polymorphonuclear cells; RT-PCR, reverse transcription PCR.
Page created: March 01, 2022
Page updated: April 19, 2022
Page reviewed: April 19, 2022
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