A Pediatric Case of Leptospirosis Developed after COVID-19 Associated Multisystem Inflammatory Syndrome
-
Kiana Razavi
,
Leila Shahbaznejad
,
Azin Hajialibeig
,
Mohammad Reza Navaeifar
,
Ali Sadeghi Lotfabadi
,
Mohammad Sadegh Rezai
Abstract
While presentations of novel severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) were observed to be mild in children, multi-system inflammatory syndrome in children (MIS-C) has emerged as one of the most critical phenomena in the era of Coronavirus disease 2019 (COVID-19). We present an eight-year-old boy with
prolonged fever, weakness, myalgia, arthralgia, oliguria, hematuria, hemoptysis, and periumbilical pain. With regards to the history of contact with SARS-CoV-2 four weeks prior to symptom onset and prominent gastrointestinal symptoms, MIS-C was highly suspected. Furthermore, based on the compatible symptoms and history of white-water rafting and exposure to contaminated soil two weeks prior to admission, leptospirosis was probable. Of note, Leptospirosis immunoglobulin M and COVID-19 immunoglobulin G were detectable. Lifesaving supportive measures, empirical antibiotic therapy, Remdesivir, Dexamethasone, and Prednisolone pulse therapy were prescribed. Afterward, gradual clinical improvement was shown. We aimed to report a case with MIS-C accompanied by severe leptospirosis to emphasize that in endemic areas of leptospirosis, considering the co-occurrence of MIS-C and other inflammatory disorders is crucial for multidisciplinary management.
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[21] Navaeifar MR, Poudineh Ghazaghi M, Shahbaznejad L, et al. Fever with Rash is One of the First Presentations of COVID-19 in Children: A Case Report. Int Med Case Rep J. 2020;13:335- 40. https://doi.org/10.2147/IMCRJ.S262935
[22] Stiles WW, Goldstein JD, Mc CW. Leptospiral nephritis. JAMA. 1946;131:1271-4. https://doi.org/10.1001/jama.1946.02870 330017005
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[24] Yang L. Acute Kidney Injury in Asia. Kidney Dis (Basel). 2016;2(3):95-102. https://doi.org/10.1159/000441887
[25] Trowbridge AA, Green JB 3rd, Bonnett JD, Shohet SB, Ponnappa BD, McCombs WB 3rd. Hemolytic Anemia Associated with Leptospirosis. Morphologic and Lipid Studies. Am J Clin Pathol. 1981;76(4):493-8. https://doi.org/10.1093/ajcp/76.4.493
[26] Almoosa ZA, Al Ameer HH, AlKadhem SM, Busaleh F, AlMuhanna FA, Kattih O. Multisystem Inflammatory Syndrome
in Children, the Real Disease of COVID-19 in Pediatrics - A Multicenter Case Series From Al-Ahsa, Saudi Arabia. Cureus.
2020;12(10):e11064 . https://doi.org/10.7759/cureus.11064
[27] Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463. https://doi. org/10.1148/radiol.2020200463
[28] Gulati S, Gulati A. Pulmonary manifestations of leptospirosis. Lung India. 2012;29(4):347-53.
https://doi.org/10.4103/0970-2113.102822
[2] Shahbaznejad L, Navaeifar MR, Abbaskhanian A, Hosseinzadeh F, Rahimzadeh G, Rezai MS. Clinical characteristics of 10 children with a pediatric inflammatory multisystem syndrome associated with COVID-19 in Iran. BMC Pediatr. 2020;20(1):513. https://doi.org/10.1186/s12887-020-02415-z
[3] Shahbaznejad L, Rouhanizadeh H, Navaeifar MR, Hosseinzadeh F, Movahedi FS, Rezai MS. Clinical characteristics and outcomes of COVID-19 in children in Northern Iran. Int J Pediatr. 2021;2021:5558287. https://doi.org/10.1155/2021/5558287
[4] Castagnoli R, Votto M, Licari A, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020;174(9):882-9. https://doi.org/10.1001/jamapediatrics. 2020.1467
[5] Navaifar M, Shahbaznejad L, Lotfabadi A, Rezai MS. COVID-19-Associated Multisystem Inflammatory Syndrome Complicated with Giant Coronary Artery Aneurysm. Case Rep Pediatr. 2021;2021:1-6. https://doi.org/10.1155/2021/8836403
[6] Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children (Basel). 2020;7(7):69. https://doi.org/10.3390/ children7070069
[7] Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during
COVID-19 pandemic. Lancet. 2020;395(10237):1607-8. https://doi.org/10.1016/S0140-6736(20)31094-1
[8] Mosalli R, Al Matrafi A, Ghazi MA, Aboumousatafa GA, Paes B. COVID-19 Infection in Spinal Muscular Atrophy Associated with Multisystem Inflammatory Syndrome. Case Rep Pediatr. 2021;2021:5862444. https://doi.org/10.1155/2021/5862444
[9] Giacalone M, Scheier E, Shavit I. Multisystem inflammatory syndrome in children (MIS-C): a mini-review. Int J Emerg Med. 2021;14(1):50. https://doi.org/10.1186/s12245-021-00373-6
[10] Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol. 2015;387:65-97. https://doi.
org/10.1007/978-3-662-45059-8_5
[11] Alikhani A, Babamahmoodi F, Alian S, Zameni F, Ghorbani A, Shojaeefar A. Sero-Epidemiological Study of Leptospirosis in Healthy People in Qaemshahr, Iran, 2015. J Mazandaran Univ Med Sci. 2016;26(140):78-84.
[12] Lopes AA, Costa E, Costa YA, et al. Comparative study of the in-hospital case-fatality rate of leptospirosis between pediatric and adult patients of different age groups. Rev Inst Med Trop Sao Paulo. 2004;46(1):19-24. https://doi.org/10.1590/S0036-46652004000100004
[13] Guerrier G, Hie P, Gourinat AC, et al. Association between age and severity to leptospirosis in children. PLoS Negl Trop Dis. 2013;7(9):e2436 . https://doi.org/10.1371/journal.pntd.0002436
[14] Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol.
2020;20(8):453-4. https://doi.org/10.1038/s41577-020-0367-5
[15] Chou J, Platt CD, Habiballah S, et al. Mechanisms underlying genetic susceptibility to multisystem inflammatory syndrome in children (MIS-C). J Allergy Clin Immunol. 2021;148(3):732-8. e1. https://doi.org/10.1016/j.jaci.2021.06.024
[16] Valitutti F, Verde A, Pepe A, et al. Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID-19 era. J Pediatr Surg Case Rep. 2021;69:101838. https://doi.org/10.1016/j.epsc.2021.101838
[17] Lee MS, Liu YC, Tsai CC, Hsu JH, Wu JR. Similarities and Differences Between COVID-19-Related Multisystem
Inflammatory Syndrome in Children and Kawasaki Disease. Front Pediatr. 2021;9:640118. https://doi.org/10.3389/
fped.2021.640118
[18] Ouldali N, Toubiana J, Antona D, et al. Association of Intravenous Immunoglobulins Plus Methylprednisolone vs
Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA. 2021;325(9):855- 64. https://doi.org/10.1001/jama.2021.0694
[19] Karpagam KB, Ganesh B. Leptospirosis: a neglected tropical zoonotic infection of public health importance-an updated review. Eur J Clin Microbiol Infect Dis. 2020;39(5):835-46. https://doi.org/10.1007/s10096-019-03797-4
[20] Medeiros FR, Spichler A, Athanazio DA. Leptospirosisassociated disturbances of blood vessels, lungs and hemostasis. Acta Trop. 2010;115(1):155-62. https://doi.org/10.1016/j. actatropica.2010.02.016
[21] Navaeifar MR, Poudineh Ghazaghi M, Shahbaznejad L, et al. Fever with Rash is One of the First Presentations of COVID-19 in Children: A Case Report. Int Med Case Rep J. 2020;13:335- 40. https://doi.org/10.2147/IMCRJ.S262935
[22] Stiles WW, Goldstein JD, Mc CW. Leptospiral nephritis. JAMA. 1946;131:1271-4. https://doi.org/10.1001/jama.1946.02870 330017005
[23] Sethi SK, Rana A, Adnani H, et al. Kidney involvement in multisystem inflammatory syndrome in children: a pediatric nephrologist’s perspective. Clin Kidney J. 2021;14(9):2000-11. https://doi.org/10.1093/ckj/sfab073
[24] Yang L. Acute Kidney Injury in Asia. Kidney Dis (Basel). 2016;2(3):95-102. https://doi.org/10.1159/000441887
[25] Trowbridge AA, Green JB 3rd, Bonnett JD, Shohet SB, Ponnappa BD, McCombs WB 3rd. Hemolytic Anemia Associated with Leptospirosis. Morphologic and Lipid Studies. Am J Clin Pathol. 1981;76(4):493-8. https://doi.org/10.1093/ajcp/76.4.493
[26] Almoosa ZA, Al Ameer HH, AlKadhem SM, Busaleh F, AlMuhanna FA, Kattih O. Multisystem Inflammatory Syndrome
in Children, the Real Disease of COVID-19 in Pediatrics - A Multicenter Case Series From Al-Ahsa, Saudi Arabia. Cureus.
2020;12(10):e11064 . https://doi.org/10.7759/cureus.11064
[27] Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463. https://doi. org/10.1148/radiol.2020200463
[28] Gulati S, Gulati A. Pulmonary manifestations of leptospirosis. Lung India. 2012;29(4):347-53.
https://doi.org/10.4103/0970-2113.102822
| Files | ||
| Issue | Vol 9 No 4 (2024): July-August | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v9i4.17979 | |
| Keywords | ||
| Multisystem inflammatory syndrome in children (MIS-C) COVID-19 Leptospirosis Pediatrics | ||
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How to Cite
1.
Razavi K, Shahbaznejad L, Hajialibeig A, Navaeifar MR, Sadeghi Lotfabadi A, Rezai MS. A Pediatric Case of Leptospirosis Developed after COVID-19 Associated Multisystem Inflammatory Syndrome. CRCP. 2025;9(4):146-151.
