The patient resumed basketball successfully in a stepwise manner as advised. At five months from initial presentation, he continues to participate safely and remains without symptoms without medication.
The patient
A young adolescent male who participates in competitive football and basketball and with history of recent COVID-19 infection was admitted to the pediatric intensive care unit at Norton Children’s Hospital. The initial workup was consistent with multisystem inflammatory syndrome in children (MIS-C), and clinical presentation was consistent with severe MIS-C with respiratory, liver and heart involvement.
Treatment was initiated as per hospital inpatient protocol.
Initial echocardiogram showed dilation of left coronary artery system and low normal left and right ventricular systolic function.
Parasternal short axis image showing dilated left anterior descending coronary artery on initial study at presentation
The patient made clinical progress with appropriate therapy and was able to be weaned off support and discharged on inpatient day five. Close outpatient follow-up was arranged prior to discharge.
At two-week follow-up, his coronary artery changes seemed to have resolved, and he had only mild clinical symptoms.
The challenge
At six-week follow-up, coronary artery changes recurred, unlike our experience with most other patients with MIS-C. There was involvement of the left main and left anterior descending coronary arteries.
Parasternal short axis image of left coronary artery system at six weeks showing persistent dilatation of left anterior descending coronary artery
Medical therapy was continued, and the patient was followed closely. At nine weeks, coronary artery changes had resolved, and the patient was weaned off medications.
A cardiac MRI performed at three months from initial presentation showed mild dilation of both ventricles and borderline normal to mildly depressed myocardial function. The results could be indicative of persistent cardiac involvement or early development of cardiomyopathy, making participation in sports controversial. The patient sought clearance to resume competitive sports.
The Norton Children’s MIS-C Multidisciplinary Clinic providers
Julianne V. Green, M.D.
Norton Children’s Infectious Diseases, affiliated with the UofL School of Medicine
Syeda S. Maqsood, M.D.
Norton Children’s Heart Institute, affiliated with the UofL School of Medicine
Kenneth N. Schikler, M.D.
Norton Children’s Rheumatology, affiliated with the UofL School of Medicine
The solution
In consultation with radiology, pediatric heart failure and exercise physiology teams, it was determined to be relatively safe and healthful for the patient to resume sports participation. Risk-sharing was discussed appropriately with the family before allowing him to participate. Additionally, the patient was evaluated by our pediatric heart failure team to ensure appropriate testing and counseling were performed prior to full sports participation.
The result
The patient resumed basketball successfully in a stepwise manner as advised. At five months from initial presentation, he continues to participate safely and remains without symptoms without medication. Pediatric cardiology and pediatric heart failure teams are continuing to follow him longitudinally until complete recovery.
Refer a patient
To refer a patient to Norton Children’s MIS-C Multidisciplinary Clinics, visit Norton EpicLink.
