Mary Wilson
Well-known member
Volume 238, October 2022, 154106
https://doi.org/10.1016/j.prp.2022.154106
ManaTaweevisit[SUP]a[/SUP][SUP]b[/SUP]AriyaChindamporn[SUP]b[/SUP][SUP]c[/SUP]KritsapornSujjavorakul[SUP]d[/SUP][SUP]e[/SUP]RujipatSamransamruajkit[SUP]b[/SUP][SUP]e[/SUP]Paul ScottThorner[SUP]a[/SUP][SUP]f[/SUP]
Highlights
•We report the first autopsy on a MIS-C patient from Asia, the 6th reported worldwide.
•Autopsy showed disseminated aspergillosis and SARS-COV-2 virus in multiple organs.
•This is the first report of aspergillosis in a MIS-C patient.
•Persistence of SARS-COV-2 has been found in all reported autopsies of MIS-C patients.
•MIS-C as a post-infectious hyperimmune reaction may be an oversimplification.
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is an emerging phenomenon associated with SARS-COV-2 infection (COVID-19) occurring in < 1 % of infected children. MIS-C is characterized by a hyperinflammatory state with excessive cytokine release (‘storm’) leading to hemodynamic compromise and multiorgan failure, with a death rate of ∼2 %. Autopsy examination can play a particularly important role in helping to understand the pathogenesis of MIS-C. Yet, only five autopsy studies have been reported to date. We report a fatal case of MIS-C involving a previously healthy, 5-year-old Thai boy admitted with MIS-C, one month after exposure to SARS-COV-2. While in intensive care, he was found to have a hypertrophic cardiomyopathy, and despite immunosuppressive treatment for MIS-C, developed shock and died. Multiorgan inflammation was not found at autopsy, implying that the MIS-C had responded to treatment. However, there was disseminated aspergillosis and cytomegalovirus reactivation, attributed to the immunosuppression. SARS-COV-2 virus was also found in multiple organs. To the best of our knowledge, this is the first reported autopsy of an MIS-C patient from Asia, and the first report of aspergillosis in MIS-C. This case underscores that the risks of immunosuppression are also a concern in MIS-C. Although MIS-C is generally considered to be a post-infectious hyperimmune reaction, persistence of SARS-COV-2 is a feature in all autopsies of MIS-C patients reported to date, suggesting a possible role in the pathogenesis, at least in fatal cases.
https://www.sciencedirect.com/science/article/pii/S0344033822003508
https://doi.org/10.1016/j.prp.2022.154106
ManaTaweevisit[SUP]a[/SUP][SUP]b[/SUP]AriyaChindamporn[SUP]b[/SUP][SUP]c[/SUP]KritsapornSujjavorakul[SUP]d[/SUP][SUP]e[/SUP]RujipatSamransamruajkit[SUP]b[/SUP][SUP]e[/SUP]Paul ScottThorner[SUP]a[/SUP][SUP]f[/SUP]
Highlights
•We report the first autopsy on a MIS-C patient from Asia, the 6th reported worldwide.
•Autopsy showed disseminated aspergillosis and SARS-COV-2 virus in multiple organs.
•This is the first report of aspergillosis in a MIS-C patient.
•Persistence of SARS-COV-2 has been found in all reported autopsies of MIS-C patients.
•MIS-C as a post-infectious hyperimmune reaction may be an oversimplification.
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is an emerging phenomenon associated with SARS-COV-2 infection (COVID-19) occurring in < 1 % of infected children. MIS-C is characterized by a hyperinflammatory state with excessive cytokine release (‘storm’) leading to hemodynamic compromise and multiorgan failure, with a death rate of ∼2 %. Autopsy examination can play a particularly important role in helping to understand the pathogenesis of MIS-C. Yet, only five autopsy studies have been reported to date. We report a fatal case of MIS-C involving a previously healthy, 5-year-old Thai boy admitted with MIS-C, one month after exposure to SARS-COV-2. While in intensive care, he was found to have a hypertrophic cardiomyopathy, and despite immunosuppressive treatment for MIS-C, developed shock and died. Multiorgan inflammation was not found at autopsy, implying that the MIS-C had responded to treatment. However, there was disseminated aspergillosis and cytomegalovirus reactivation, attributed to the immunosuppression. SARS-COV-2 virus was also found in multiple organs. To the best of our knowledge, this is the first reported autopsy of an MIS-C patient from Asia, and the first report of aspergillosis in MIS-C. This case underscores that the risks of immunosuppression are also a concern in MIS-C. Although MIS-C is generally considered to be a post-infectious hyperimmune reaction, persistence of SARS-COV-2 is a feature in all autopsies of MIS-C patients reported to date, suggesting a possible role in the pathogenesis, at least in fatal cases.
https://www.sciencedirect.com/science/article/pii/S0344033822003508