Family Transmission of COVID-19 Including a Child with MIS-C and Acute Pancreatitis
Received 17 October 2020
Accepted for publication 9 December 2020
Published 5 February 2021 Volume 2021:14 Pages 55—65
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Ronald Prineas
Maher Abbas,1 Carl-Johan Törnhage1,2
1Department of Paediatrics, Skaraborg Hospital, Skövde, Sweden; 2Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Correspondence: Carl-Johan Törnhage
Department of Paediatrics, Skaraborg Hospital, SE, 54185, Skövde, Sweden
Tel +46-720 34 51 75
Fax +46-500 47 83 56
Introduction: Spread of the novel coronavirus SARS-CoV-2, since at least December 2019, has caused a pandemic. SARS-CoV-2 causes the disease COVID-19, which can affect several human organs. Abdominal pain is one of the known symptoms, but little is known about acute pancreatitis as a complication. As well, knowledge about viral transmission in families is limited. This case report describes MIS-C and acalculous acute pancreatitis in a child who was a member of a family in which four of five members had COVID-19.
Case Report: A previously healthy family was infected by SARS-CoV-2 from an unknown source. The 13-year-old daughter was infected by SARS-CoV-2 and symptomatic during two periods, with an asymptomatic interval in-between. During the first period, she had transient and mild upper respiratory symptoms which was followed four weeks later by a secondary severe illness. At that point, there was inflammation in multiple organs and signs of Multisystem Inflammatory Syndrome in Children (MIS-C) and a Kawasaki-like disease with skin rash, scalded skin in hands and conjunctivitis. Myocarditis, bronchopneumonia, pancreatitis, and hepatopathy without encephalopathy were noted. She required assisted ventilation for 5 days. There were laboratory signs of disseminated intravascular coagulopathy. The multisystem inflammation was treated with intravenous immunoglobulin (IVIG) once a day for four days and immunotherapy (high dose methylprednisolone (IV) once a day, for 12 days, then tapered over 4 weeks, anakinra (IV) four times daily for 12 days), low molecular weight heparin for 22 days and salicylates for 6 weeks leading to full restoration of health. The two brothers and mother in the family had mild to moderate COVID-19 infections. The father was not affected despite close contact with his children. The household transmission and clinical course and outcome are described. No further known COVID-19 infection occurred in the neighborhood during or immediately after the family cluster was discovered.
Conclusion: Penetrance and severity of COVID-19 can vary in family clusters. One adolescent showed a two-phase course with severe infection. This case report highlights MIS-C and acute pancreatitis as a complication associated with COVID-19 in children.
Keywords: children, coronavirus, COVID-19, Kawasaki disease, multisystem inflammatory syndrome in children, MIS-C, pancreatitis, paediatric inflammatory multisystem syndrome, PIMS
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