Disclosures: Stephen H. Luebbert, MD: No financial relationships or conflicts of interest

Case Diagnosis: The case discusses the treatment course of a 3-year-old child with coronavirus disease 2019 (COVID-19) and subsequent cerebral vascular accident and splenic infarction.

Case Description: A 3-year-old boy presented with septic shock after 4 days of nausea, vomiting, diarrhea, fever, poor oral intake, and abdominal rash. Ultimately diagnosed with COVID-19 and multisystem inflammatory syndrome in children (MIS-C), an associated complication. He subsequently developed acute right-sided hemiparesis and magnetic resonance imaging/angiography identified a left middle cerebral artery (MCA) M2 occlusion of the superior temporal branch with corresponding MCA territory infarction. Mechanical thrombectomy was performed, with the patient requiring transient intubation. He was given intravenous immunoglobulin (IVIG), methylprednisolone, aspirin, and low-molecular-weight heparin. He required inpatient rehabilitation and was able to ambulate unassisted on discharge. To determine further risk factors of the stroke, a coagulation panel was ordered, which resulted in positive findings for heterozygous Factor V Leiden mutation. The patient was noted to have generalized abdominal swelling with workup and subsequent imaging revealing coexistent splenic infarction.

Setting: Academic pediatric hospital.Assessment/

Results: The patient was last evaluated in the Pediatric PM&R clinic three weeks post-discharge and was noted to have made a remarkable recovery, demonstrating a normal gait pattern with only very mild right ankle plantar flexor spasticity on examination.

Discussion: MIS-C is an emerging complication of COVID-19 in children and may require inpatient rehabilitation. The patient’s stroke and splenic infarction were likely precipitated by MIS-C but further compounded by an underlying Factor V Leiden mutation.

Conclusion: An interdisciplinary team is required, especially with pediatric patients, in the optimal treatment of MIS-C. Given the coagulopathy associated with COVID-19, this report underscores the need for early rehabilitation and interdisciplinary/multispecialty efforts for those with COVID-19. This report may also suggest further screening coagulation panels to monitor for inherent coagulopathies in young patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/covid-19-multisystem-inflammatory-syndrome-precipitating-rare-cerebral-vascular-accident-in-3-year-old-child-with-factor-v-leiden-mutation-a-case-report/