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Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children

Open access
Grimaud, Marion, Starck, Julie, Levy, Michael, Marais, Clémence, Chareyre, Judith, Khraiche, Diala, Leruez-Ville, Marianne, Quartier, Pierre, Léger, Pierre Louis, Geslain, Guillaume, Semaan, Nada, Moulin, Florence, Bendavid, Matthieu, Jean, Sandrine, Poncelet, Géraldine, Renolleau, Sylvain, Oualha, Mehdi·2020·Annals of Intensive Care

Abstract

Background: A recent increase in children admitted with hypotensive shock and fever in the context of the COVID-19 outbreak requires an urgent characterization and assessment of the involvement of SARS-CoV-2 infection. This is a case series performed at 4 academic tertiary care centers in Paris of all the children admitted to the pediatric intensive care unit (PICU) with shock, fever and suspected SARS-CoV-2 infection between April 15th and April 27th, 2020. Results: 20 critically ill children admitted for shock had an acute myocarditis (left ventricular ejection fraction, 35% (25–55); troponin, 269 ng/mL (31–4607)), and arterial hypotension with mainly vasoplegic clinical presentation. The first symptoms before PICU admission were intense abdominal pain and fever for 6 days (1–10). All children had highly elevated C-reactive protein (> 94 mg/L) and procalcitonin (> 1.6 ng/mL) without microbial cause. At least one feature of Kawasaki disease was found in all children (fever, n = 20, skin rash, n = 10; conjunctivitis, n = 6; cheilitis, n = 5; adenitis, n = 2), but none had the typical form. SARS-CoV-2 PCR and serology were positive for 10 and 15 children, respectively. One child had both negative SARS-CoV-2 PCR and serology, but had a typical SARS-CoV-2 chest tomography scan. All children but one needed an inotropic/vasoactive drug support (epinephrine, n = 12; milrinone, n = 10; dobutamine, n = 6, norepinephrine, n = 4) and 8 were intubated. All children received intravenous immunoglobulin (2 g per kilogram) with adjuvant corticosteroids ( n = 2), IL 1 receptor antagonist ( n = 1) or a monoclonal antibody against IL-6 receptor ( n = 1). All children survived and were afebrile with a full left ventricular function recovery at PICU discharge. Conclusions: Acute myocarditis with intense systemic inflammation and atypical Kawasaki disease is an emerging severe pediatric disease following SARS-CoV-2 infection. Early recognition of this disease is needed and referral to an expert center is recommended. A delayed and inappropriate host immunological response is suspected. While underlying mechanisms remain unclear, further investigations are required to target an optimal treatment.

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Metadata

Authors
Grimaud, M., Starck, J., Levy, M., Marais, C., Chareyre, J., Khraiche, D., Leruez-Ville, M., Quartier, P., Léger, P. L., Geslain, G., Semaan, N., Moulin, F., Bendavid, M., Jean, S., Poncelet, G., Renolleau, S., & Oualha, M.
Venue
Annals of Intensive Care
Publisher
Elsevier BV
Published
2020-06-01
Volume
10
Issue
1
Pages
69-69
ISSN
2110-5820 (ISSN-L)
OpenAlex
W3031924236
Cited by
319
References
16
FWCI
61.61
Type
journal article
Language
en
Open access
gold

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CoChat. (2026). Citation check: Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. https://app.cochat.ai/papers/10.1186/s13613-020-00690-8
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Grimaud, M., Starck, J., Levy, M., Marais, C., Chareyre, J., Khraiche, D., Leruez-Ville, M., Quartier, P., Léger, P. L., Geslain, G., Semaan, N., Moulin, F., Bendavid, M., Jean, S., Poncelet, G., Renolleau, S., & Oualha, M. (2020). Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Annals of Intensive Care. https://doi.org/10.1186/s13613-020-00690-8

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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