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The challenges of multisystem inflammatory syndrome diagnosis and treatment

  • Saulė Kiaunytė1,*,
  • Rima Šileikienė1

1Pediatric Department, Hospital of Lithuanian University of Health Sciences Kauno klinikos, LT-50161 Kaunas, Lithuania

DOI: 10.22514/sv.2023.042 Vol.20,Issue 2,February 2024 pp.105-109

Submitted: 29 December 2022 Accepted: 10 March 2023

Published: 08 February 2024

*Corresponding Author(s): Saulė Kiaunytė E-mail:


A two-year-old girl with fever, diarrhea and vomiting was presented to the Emergency Department (ED). A maculopapular rash on the face, cervical lymphadenopathy and 1st degree dehydration were being noted. Laboratory results showed leukocytosis, neutrophilia and a high level of C-reactive protein (CRP). Amoxicillin was prescribed, but the patient’s state did not improve. She returned to ED with rash all over her body and 2nd degree dehydration. Laboratory results revealed thrombocytopenia and a more increased level of CRP. It was found that her mother has been diagnosed with the coronavirus disease approximately two months ago. Extended laboratory results showed signs of mild anemia, increased levels of liver enzymes, procalcitonin, troponin, N-terminal prohormone of brain natriuretic peptide, D-dimers, ferritin. Anti-SARS-CoV-2 (severe acute respiratory syndrome-coronavirus) IgG (immunoglobulin G) were detected. Multisystem inflammatory syndrome was diagnosed. Pediatric echocardiography revealed 10 mm of fluids in pericardium, I degree mitral valve regurgitation, dilated left coronary artery. She was given a treatment with intravenous Immunoglobulin G, methylprednisolone and aspirin, but her state did not improve. A treatment with Tocilizumab was given, but it did not have a much more positive effect, laboratory results showed progressed leucocytosis and neutrophilia. As the last resort, biology treatment with a recombinant form of human interleukin-1 receptor antagonist Anakinra was started and after a week all symptoms changed, and laboratory results regressed.


Multisystem inflammatory syndrome; Coronavirus; Prolonged fever; Dilated coronary artery

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Saulė Kiaunytė,Rima Šileikienė. The challenges of multisystem inflammatory syndrome diagnosis and treatment. SignaVitae. 2024. 20(2);105-109.


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