case_images: PMC10126396_01
case_images: PMC10126396_02
case_images: Correlation between administration of IVIG and severe hemolytic anemia: time course of Hb, treatment of PIMS-TS, and recurrent fever episodes. *admission to hospital; Prednisolone (2 mg/kg/day): Patient 1 and Patient 2 for 3 weeks; Acetylsalicylic acid (5 mg/kg b.w./day): Patient 1 for 10 months, Patient 2 for 5 weeks; Low-molecular-weight heparins (1 mg/kg b.w./d): Patient 1 for 3 weeks, Patient 2 for 5 weeks; Interleukin-1 receptor antagonist (anakinra:100 mg subcutaneously/3 times/week): Patient 2 for 4 weeks. Patient 1: first administration of IVIG 2 g/kg:9 days after onset of PIMS-TS; second administration of IVIG 2 g/kg about 40 h after the first administration. Patient 2: first administration of IVIG 2 g/kg 5 days after onset of PIMS-TS; second administration of IVIG 2 g/kg 4 days after the first administration. PIMS-TS, pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV2; IVIG, intravenous immunoglobulin; Hb, hemoglobin.
case_images: fped-11-1144914-g001.jpg
case_images: PMC10126396_02_fped-11-1144914-g001.jpg
case_images: F1
case_images: The initial dose of IVIGs (2 g/kg b.w./day) was administered within the first 4 days after admission (Figure 1). Therefore, both received a second administration of IVIGs within 10 days after the onset of symptoms (Figure 1). Patient 1 received the second IVIGs approximately 40 h after the first administration, whereas patient 2 received the second IVIG administration 4 days after the first dose (Figure 1). Subsequently, patient 1 presented with symptomatic hemolytic anemia with pallor, massive weakness, inability to walk, and decreased hemoglobin (Hb) (from 10.4 to 5.8 g/dl), increased lactate dehydrogenase (LDH) (247-1,101 U/L), and nondetectable haptoglobin (Table 1, Figure 1).