case_images: PMC9194446_01
case_images: Treatment and clinical course of the patient. CTRX, ceftriaxone; IVIG, intravenous immunoglobulin infusion; mPSL, methylprednisolone pulse; CsA, ciclosporin A; DOB, dobutamine; LV FS, left ventricular fractional shortening; BT, body temperature; CRP, C-reactive protein (reference range < 0.14); WBC, white blood cell (reference range 4,000-10,700); BNP, B-type natriuretic peptide (reference range < 18.4); Toroponin I (reference range < 26.2); CTR, cardiothoracic ratio.
case_images: fped-10-890755-g001.jpg
case_images: PMC9194446_01_fped-10-890755-g001.jpg
case_images: F1
case_images: Furthermore, cardiomegaly (cardiothoracic ratio: CTR; 54.6%) and pulmonary congestion were seen on both chest X-ray and computed tomography examinations, and intestinal gas showed prominent expansion on an abdominal X-ray (Supplementary Figures 1A,B). Electrocardiogram showed sinus tachycardia (heart rate: 142 beats/min), with flat and negative T waves on the V5 and V6 leads, suggesting myocardial damage (Supplementary Figure 1C). Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and Royal College of Paediatrics and Child Health (RCPCH) criteria. His clinical disease course following hospitalization is shown in Figure 1.
case_images: Representative cytokines that responded to each treatment. We classified the treatment response when the cytokine decreased by 50% from the peak levels, referenced to the day 166 levels for each cytokine. (A) Cytokine decreased prior to initiation of treatment. (B) Cytokines that responded to methylprednisolone (mPSL) treatment. (C) Cytokines that responded to ciclosporin A (CsA) treatment. IL, interleukin; IFN, interferon; IVIG, intravenous immunoglobulin infusion.
case_images: fped-10-890755-g002.jpg
case_images: PMC9194446_01_fped-10-890755-g002.jpg
case_images: F2
case_images: We confirmed that no CAAs developed by both repeated transthoracic echocardiography and 3D computed tomography during his clinical course (Supplementary Figure 2).