Una sindrome infiammatoria multisistemica fredda complicata da shock

Abstract

Rationale - In clinical practice there are numerous factors influencing the correct process of diagnosis and treatment, especially in the context of complex clinical cases such as severe and atypical forms of "multisystem inflammatory syndrome" (MIS-C): several studies have observed that in the Emergency Department fewer than half of cases of hemodynamic shock are treated according to Paediatric Advanced Life Support (PALS) guidelines.
Objectives - To favour the recognition of MIS-C in its atypical form and to provide indications on the correct treatment in the course of its acute complications such as mixed shock (distributive-cardiogenic).
Materials and methods - Starting from the analysis of a clinical case, the literature about MIS-C and the management of mixed shock in the Emergency Department was reviewed. The paper describes the case of a patient with atypical MIS-C characterized by multiple organ failure syndrome, highlighting possible interventions of good clinical practice aimed to improve the outcome of patients affected by these disorders.
Results - The analysis of the literature and guidelines has allowed new management guidelines for atypical MIS-C syndrome to be produced, in order to obtain a better outcome, despite a highly severe clinical scenario.
Conclusions - Although there are no studies on the treatment of MIS-C shock in the literature, in view of the pathogenic continuum between MIS-C and Kawasaki syndrome, the adapted application of the American Heart Association guidelines allows the achievement of a good outcome even in cases of MIS-C with severe presentation.