Research Output

Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in a patient receiving Infliximab therapy for Inflammatory Bowel Disease

  Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 [PIMS-TS] is a newly described condition. It has a spectrum of presentations proposed to occur as part of a post-infectious immune response. We report the first case of PIMS-TS in a child on established anti-tumour necrosis factor alpha [anti-TNFα] therapy; a 10 year-old girl with ulcerative colitis treated with infliximab. The patient had 6 weeks of daily fever with mucocutaneous, gastrointestinal, renal, and haematological involvement. Biomarkers of hyperinflammation were present including: hyperferritinaemia [up to 691 µ/L; normal 15–80 µg/L], C-reactive protein [CRP] [ >100mg/L for  >10 days, normal 0–5 mg/L], erythrocyte sedimentation rate [ESR] consistently  >100mm/h [normal 0–15 mm/h], raised white cell count with neutrophilia, elevated D-dimer and lactate dehydrogenase [LDH], anaemia and Mott cells on bone marrow analysis. Extensive investigations for alternative diagnoses for pyrexia of unknown origin [PUO] were negative. The condition was refractory to treatment with intravenous immunoglobulin [IVIG] but improved within 24 h of high-dose methylprednisolone. Infliximab treatment followed and the patient has remained well at follow-up. Polymerase chain reaction [PCR] and serology for SARS-CoV-2 were negative. Current series report such negative findings in up to half of cases. The patient experienced a milder clinical phenotype without cardiac involvement, shock, or organ failure. Accepting the wide spectrum of PIMS-TS presentations, it is possible that previous anti-TNFα therapy may have attenuated the disease course. Given the uncertainty around therapeutic strategies for PIMS-TS, this case supports the need for further investigation into continuing infliximab as a treatment option for the condition.

  • Type:

    Article

  • Date:

    10 September 2020

  • Publication Status:

    Published

  • DOI:

    10.1093/ecco-jcc/jjaa201

  • ISSN:

    1873-9946

  • Funders:

    Historic Funder (pre-Worktribe)

Citation

Meredith, J., Khedim, C., Henderson, P., Wilson, D. C., & Russell, R. K. (2021). Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in a patient receiving Infliximab therapy for Inflammatory Bowel Disease. Journal of Crohn's and Colitis, 15(4), 687-691. https://doi.org/10.1093/ecco-jcc/jjaa201

Authors

Keywords

Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 [PIMS-TS], SARS-CoV-2, paediatric, inflammatory bowel disease, Covid-19

Monthly Views:

Available Documents