Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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A Case of 1-Month Fever Caused by CMV Infection in a Patient With MIS-C Treated With IVIG, Infliximab, and High-Dose Methylprednisolone

  • Gihun Jeong (Department of Pediatrics, Jeonbuk National University Children's Hospital) ;
  • Jihye You (Department of Pediatrics, Jeonbuk National University Children's Hospital)
  • Received : 2023.01.02
  • Accepted : 2024.01.14
  • Published : 2024.04.25
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Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of coronavirus disease 2019 (COVID-19), causing multi-organ damage affecting the heart, lungs, kidneys, digestive tract, and nervous system. As the cases of MIS-C have been increasing following the COVID-19 pandemic, the importance of appropriate management for MIS-C is becoming increasingly apparent. Immunomodulating agents such as anakinra, infliximab, and steroids are regarded as supplementary therapy to the first-line treatment with intravenous immunoglobulin. However, these immunomodulating therapies can potentially precipitate opportunistic infections, including those caused by cytomegalovirus (CMV), Epstein-Barr virus, and tuberculosis, or increase the risk of co-infections. Herein, we report a case of a 3-year-old boy who was treated with immunoglobulin, infliximab, and high-dose methylprednisolone for MIS-C, and subsequently developed a persistent fever lasting 32 days caused by a CMV infection.

소아 다기관 염증 증후군(multisystem inflammatory syndrome in children, MIS-C)은 코로나바이러스감염증-19 (코로나 19; coronavirus disease 2019, COVID-19)의 드문 합병증으로 심장, 폐, 신장, 소화관 및 신경계를 포함한 다기관 손상을 일으킨다. 코로나19 팬데믹 이후 MIS-C 사례가 증가함에 따라 MIS-C에 대한 적절한 치료의 중요성이 강조되고 있다. anakinra, infliximab, 스테로이드와 같은 면역 조절제는 MIS-C에 대한 intravenous immunoglobulin (IVIG)의 1차 치료에 대한 추가 요법으로 고려되지만 cytomegalovirus (CMV), Epstein-Barr 바이러스 및 결핵과 같은 2차 감염을 유발할 소지가 있다. 저자들 MIS-C로 IVIG, steroid 및 infliximab을 투여한 환자에서 동반된 CMV 감염으로 인하여 약 한달간 지속되는 발열이 발생한 3세 남아의 증례 1례를 처음으로 보고하였다.

Keywords

Acknowledgement

This study was supported by the Fund of the Biomedical Research Institute, Jeonbuk National University Hospital (2022). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations. The funding organizations had no role in the design, preparation, review, or approval of this paper.

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