Acute Severe Heart Failure in Paediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2: A Case Report

A 17-year-old boy presented during the COVID-19 pandemic in late 2021 with intractable fevers and hemodynamic instability with early gastrointestinal disturbances, resembling features of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. Our patient required intensive unit care for persistently worsening signs of cardiac failure; initial admission echocardiography demonstrated severe left ventricular dysfunction with an estimated ejection fraction of 27%. Treatment with intravenous IgG and corticosteroids showed a rapid improvement in symptoms, but further specialist cardiological input was required for heart failure in the coronary care unit. Substantial improvement in cardiac function was shown on echocardiography before discharge, initially to left ventricular ejection fraction (LVEF) 51% two days after the commencement of treatment and then to >55% four days later, and on cardiac MRI. An echocardiogram one month post-discharge was normal, and the patient reported complete resolution of heart failure symptoms by four months in addition to full restoration of functional status.