PB0594 - Acute Limb Ischemia in Multisystem Inflammatory Syndrome in Children (MISC)

Background: The occurrence of acute limb ischemia (ALI) is approximately 1.5 cases per 10,000 people per year in both adults and children. During the COVID-19 pandemic, the occurrence of ALI was five times higher in patients with COVID-19. Elevated infection markers in COVID-19 increase the susceptibility to microthrombosis, intravascular hyperpermeability, disseminated intravascular coagulation, and multiorgan failure. This case is a critical condition that requires immediate intervention due to its unfavourable prognosis and high mortality rates.

Aims: To report thrombosis of tibial arteries and superficial femoral arteries bilateral in an adolescent with COVID-19 and to discuss the multiple risk factors contributing to thrombosis.

Methods: We report a case of an early adolescent who was infected by COVID-19 led to MISC and had an ALI during inpatient care.

Results: A 10-year-old boy with history of covid 19 infection was initially admitted for a cardiac thrombus related to MISC. During heparinization he had a complaint of pain on bilateral lower limbs . The pain was accompanied by bluish skin. From physical examination the pulses was non palpable especially in the left limb. The high D-dimer (35.200 g/l), high fibrinogen (420 mg/dl,) hign NT pro BNP (1.650 pg/ml), and high C-reactive protein (13,6) became risk for coagulopathy. The patient is obese and suffered from dyslipidemia, with triglyceride levels 145 mg/dl, total cholesterol 332 mg/dl, HDL cholesterol 82 mg/dl, and LDL cholesterol 239 mg/dl. The patient underwent heparinization. Due to the persistent of the pain, he underwent thrombectomy and given thrombolytic agent (tissue plasminogen activator). He also given antiaggregating platelets (aspirin), and steroid pulse for treat MISC. Symptoms were improved within two weeks

Conclusion(s): Arterial thrombosis may be associated with MISC which presenting an inflammatory syndrome secondary to COVID-19 infection and chronic inflammation in patient with obesity and dyslipidemia.