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心筋障害により心不全を呈した小児多系統炎症性症候群(MIS-C)の1例

結城, 智康 蜂谷, 明 荒井, 萌子 島, 庸介 信州大学 DOI:10.11441/shinshumedj.71.283

2023.10.10

概要

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new disease that develops after coronavirus disease 2019 (COVID-19) and is known to cause severe inflammation in multiple organs, gastrointestinal symptoms, respiratory distress, and shock.   The patient was an 8-year-old boy who developed MIS-C one month after COVID-19 and presented with left ventricular systolic dysfunction and hypotension. Prednisolone (PSL) and high-dose immunoglobulin therapy (IVIG) improved some symptoms and part of the laboratory findings, but ferritin and D-dimer remained elevated, suggesting a cytokine storm. After infliximab (IFX) administration, ferritin and D-dimer improved, suggesting that IFX may be useful in suppressing cytokines that were not suppressed by the combination of PSL and IVIG. NT-proBNP and troponin T were elevated the day before shock and decreased with improvement in left ventricular contractility. We suggest that measurement of NT-proBNP and troponin T help in early prediction of shock in MIS-C.

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