A pediatric cardiologist discusses the specifics of a case study, the importance of adaptability, and how her healthcare system has developed treatment protocols in these cases.
Back in April, a 14-year-old boy was admitted to the emergency department at Nemours Children's Health System in Delaware with a 4-day fever, fatigue, and abdominal pain.
The patient tested negative for COVID-19 and was admitted to the general pediatric ward. By the evening of his second day in the hospital, he deteriorated with multiple issues including diarrhea, high fever, and a quickly spreading rash which also saw him experiencing chest pain, fluid in the lungs, and decreasing heart function.
During the early days of the pandemic, clinicians grappled with the presentation of unconnected symptoms, which made several diagnoses appear possible. Unbeknownst to them, the Nemours team was treating one of the first cases of multisystem inflammatory syndrome in children (MIS-C) in the United States. MIS-C is rare in children and causes inflammation of the heart, lungs and other vital organs.
Deepika Thacker, MD, is a pediatric cardiologist at Nemours who treated the patient in the cardiac intensive care unit.
In the midst of the patient’s 12 day stay at Nemours, Thacker and her team maintained a healthy skepticism of potential diagnoses and remained open to the possibility of having to change their treatment protocol.
"There are lessons to be learned from this case, the most critical being to maintain your suspicion if there are several plausible diagnoses," Thacker said. "This allowed us to remain vigilant and adapt treatment as we went, based on the signals and symptoms we were seeing."
The patient was placed on a ventilator and treated with penicillin, ceftriaxone, epinephrine, phenylephrine, milrinone, intravenous immune globulins, and high-dose aspirin to cover the wide variety of possible conditions.
Only after discharge, an antibody test showed the patient had COVID-19.
Thacker was the senior author of a subsequent paper published in Progress in Pediatric Cardiology. This case study and the retrospective diagnosis serves as an important connection of COVID-19 to the highly dangerous syndrome.
In an interview with Contagion®, Thacker discusses the case study, the clinical pathways Nemours has since developed for early recognition and treatment of MIS-C, and some insights for fellow clinicians and concerned parents about symptoms of the condition.