Open AccessPediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS‐C) and COVID‐19 Treated With Infliximab
Author(s) -
Dolinger Michael T.,
Person Hannibal,
Smith Rachel,
Jarchin Lauren,
Pittman Nanci,
Dubinsky Marla C.,
Lai Joanne
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002809
Subject(s) - medicine , infliximab , rash , inflammatory bowel disease , cytokine storm , maculopapular rash , anakinra , etanercept , gastroenterology , immunology , tumor necrosis factor alpha , disease , infectious disease (medical specialty) , covid-19
Coronavirus disease 2019 (COVID‐19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID‐19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor‐alpha (TNF‐α) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS‐CoV‐2 polymerase chain reaction was positive. Despite inpatient treatment for COVID‐19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid‐refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)‐6, IL‐8, and TNF‐α, higher than those described in either inflammatory bowel disease or severe COVID‐19 alone. The patient was treated with infliximab for TNF‐α blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID‐19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF‐α, a decrease in IL‐6, and IL‐8 concentrations. This case supports a role for blockade of TNF‐α in the treatment of COVID‐19 inflammatory cascade. The role of anti‐TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID‐19 requires further investigation.