Case report: Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 with severe myocardial dysfunction. Is there any hope in immunotherapy?

Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) develops in a small percentage of children after COVID-19, however, it might cause severe myocardial dysfunction. The pathogenesis of this disease includes systemic hyper-inflammation with cytokine storm. This case report concerns a 12-year-old boy with PIMS-TS who presented severe respiratory and circulatory failure with increased inflammatory markers and significant reduction of left ventricle ejaculatory fraction (LVEF) from 65% to 35%. The recommended therapy with the use of vasopressors, corticosteroids, intravenous immunoglobulins and mechanical ventilation was introduced and his condition gradually improved. However, after few days, aggravation of cardiac symptoms occurred again and among other treatment, the therapy with the use of anakinra - the human interleukin 1 receptor antagonist protein was introduced. This case highlights a satisfactory regression of cardiac disturbances and generally favorable outcome of the treatment in patients with PIMS-TS with the use of immunomodulatory therapy

Prenatalne podejrzenie - postnatalne rozpoznanie wady układu moczowego u dzieci

Background: Introduction of prenatal ultrasonography (USG) in fetus diagnostic caused early detection of congenital urinary tract abnormalities. Dilatation of renal pelvis, which is detected in ultrasonography from 16 week of gestational age is the most common abnormality in fetal urinary tract. The aim of the study was to assess the frequency of congenital abnormalities in urinary tract in children with prenatal suspicion of anomalies. Material/Methods: The retrospective study included 100 children with prenatal suspicion of congenital abnormalities in urinary tract. Changes in urinary tract were detected in ultrasonography between 18-41 (mean 32,6±5,6) week of gestational age. Unilateral dilatation of urinary tract was found in 57% fetuses, bilateral dilatation in 31%, others anomalies in 12% fetuses. Results: Ultrasonography of urinary tract was done in all children in 1-122 (mean 17,5±20,5) day of life, cystourethrography in 93% of children, renal dynamic scintygraphy in 52%, renal static scintygraphy in 16% and urography in 39% of children. Congenital urinary tract abnormalities were detected in 63% of children. Transient dilatation of renal pelvis was observed in 25% of children. We didn't find any abnormalities in 12% patients. The most common changes in urinary tract were: ureteropelvic junction obstruction (22%), vesicoureteral reflux (15%), ureterovesical junction obstruction (7%), posterior urethral valve (7%) and polycystic renal dysplasia (7%). 33% children were qualified for invasive treatment. Conclusions: 1. Prenatal and postnatal ultrasonography of urinary tract allows detecting congenital abnormalities of urinary tract early age of life. 2. High percentage of abnormalities in urinary tract detected in prenatal ultrasonography orders cooperation between neonatologist, urologist and nephrologist