PB0601 - Aortoiliac arterial thrombosis and renal artery stenosis in a patient with multisystem inflammatory syndrome in neonates

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Oranooj Lertkovit, MD

Pediatric hematologist and oncologist
Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Bangkok, Krung Thep, Thailand

Co-Author(s)

PS

Pichada Saengrat

Neonatologist
Division of Neonatology and Perinatology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Bangkok, Krung Thep, Thailand
DI

Daranee Isaranimitkul

Pediatric hematologist/oncologist
Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Bangkok, Krung Thep, Thailand
SP

Suwanna Pornrattanarungsri

Pediatric cardiologist
Division of Cardiology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Bangkok, Krung Thep, Thailand
OS

Ornatcha Sirimongkolchaiyakul

Pediatric nephrologist
Division of Nephrology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Bangkok, Krung Thep, Thailand
ST

Sirikarn Tangcheewinsirikul

Pediatric rheumatologist
Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University
Bangkok, Krung Thep, Thailand

Background: Multisystem inflammatory syndrome in neonates (MIS-N) is a rare hyperinflammatory condition associated with perinatal or postnatal SARS-CoV-2 exposure, resulting in multiorgan dysfunction. Common clinical manifestations include cardiovascular instability, respiratory compromise, coagulopathy, and encephalopathy. Prior studies have reported a significant hypercoagulable state and thrombosis among multisystem inflammatory syndrome in children (MIS-C). However, data on thrombosis in MIS-N are still limited.

Aims: To report a patient with MIS-N complicated with aortoiliac arterial thrombosis and renal artery stenosis.

Methods: A retrospective review of the patient's medical history was performed.

Results: A 2-day-old Thai full-term male neonate, presenting with fever, respiratory failure, severe persistent pulmonary hypertension, and shock, was diagnosed with MIS-N. Along with aggressive cardiopulmonary management, the patient initially responded to a treatment with intravenous immunoglobulin, methylprednisolone, and low-dose aspirin. Since the 11th day of life, he developed severe hypertension. The blood tests revealed a hemoglobin level of 10.7 g/dL, and mildly elevated D-dimer (0.66 mg/L). A computed tomography angiography (CTA) suggested thrombosis in the juxta-renal abdominal aorta and the left internal iliac artery with severe narrowing of the right renal artery. Treatment including antihypertensive drugs and enoxaparin were administrated. Additionally, methylprednisolone was restarted to control inflammation. The follow-up magnetic resonance angiography (MRA) of the whole aorta showed an overall improvement of the thrombosis, but the narrowing of the proximal part of the right renal artery persisted. Due to uncontrolled hypertension, he underwent percutaneous transluminal balloon angioplasty in the right renal artery, and received enoxaparin for 7 days after the operation.

Conclusion(s): Thromboembolic events are severe and life-threatening complication of MIS-N. Therefore, early laboratory testing, especially D-dimer and diagnostic imaging in cases of clinically-suggested thrombosis, may be indicated to ensure prompt diagnosis and management initiation. Thromboprophylaxis should be considered in patients with MIS-N.