Page 90 - GPD-2-3

Gene & Protein in Disease MIS-A with LETM after SARS-CoV-2 vaccine

Table 1. Results of preliminary investigation
December 27, 2021 December 28, 2021; December 28, 2021; December 29, 2021
morning evening
Hemoglobin (mmol/L) 1.61 1.49 1.63 1.64
Total leukocyte count (/L) 11.01×10 9 13.7×10 9 19.9×10 9 18.9×10 9
Differential leukocyte count P73L20% P95L3.5% P95L5%, P93L4%
Platelets (/L) 176×10 9 68×10 9 70×10 9 44×10 9
Blood urea nitrogen (mmol/L) 5.71 / 12.5 12.5
Creatinine (μmol/L) 64.5 / 348.3 384.5
Total bilirubin/direct (μmol/L) / 80.5/34.9 / 122.8/74.9
SGOT/SGPT (μKat/L) 0.4/0.33 2.09/0.9 7.02/3.32 7.6/3.39
Sodium/potassium/calcium (mmol/L) 139/4.05/7.7 136/4.1/7.6 132/3.6/7.5 139/3.9/7.7
PT/APTT/INR (s) / / 22.7 (13.6)/70 (33)/1.71 34.3 (13.6)/79.8 (33)/2.64
D dimer/Fib / / / >Max/-
Peripheral blood smear / / Normocytic macrocytes, /
schistocytes and
no toxic granules
Urine routine and culture / Normal/no growth / /
Blood culture / No growth / /
Miscellaneous • Serum porphyrins: • U1‑nRNP/Sm: negative • CSF‑Cells‑02 • Spot urine protein: 495
negative • Sm: negative • Glucose (CSF/serum): mg/dl
• CPK: normal • SS‑A: negative 1.14/2.56 mmol/L • ABG: respiratory alkalosis
• ABG: normal • Ro‑52: negative • Protein: 1050 mg/L, • CPK: 316 U/L
• Thyroid function test: • SS‑B/La: negative • Stains: negative • CPK‑MB: 0.43 μKat/L
normal • Scl‑70: negative • COVID antibody • Dengue/malaria/typhoid/
• RT‑PCR for • Pm‑Scl: negative (total): 2816 IU/mL leptospira/scrub typhus/
SARS‑CoV‑2: negative • Jo‑1: negative (normal<1000 IU/mL) lyme: negative
• CENP‑B: negative • NT‑ProBNP: >8260
• PCNA: negative pmol/L
• dsDNA: negative • Procalcitonin: >200 ng/mL
• ANA (IF) : negative • CRP: 1240 mg/L
• cANCA/pANCA: negative • HBsAg/Anti HCV/HIV/
VDRL: negative
• USG (W/A): normal
• 2D echocardiography:
global left ventricular
hypokinesia
• LVEF: 45%
Note: /: Not done. Abbreviations: ABG: Arterial blood gas; ANA: Antinuclear antibody; ANCA: Antineutrophilic cytoplasmic antibody; APTT:
Partial thromboplastin time–activated; cANCA: ANCA that targets proteinase 3; CRP: C‑reactive protein; CSF: Cerebrospinal fluid; CPK: Creatine
phosphokinase; dsDNA: Double‑stranded DNA; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus;
INR: International normalized ratio; LVEF: Left ventricular ejection fraction; pANCA: ANCA that targets myeloperoxidase; PCNA: Proliferating cell
nuclear antigen; PT: Prothrombin time; RT‑PCR: Reverse‑transcription polymerase chain reaction; SGOT: Serum glutamic‑oxaloacetic transaminase;
SGPT: Serum glutamic‑pyruvic transaminase; USG (W/A): Ultrasonography of whole abdomen; VDRL: Venereal disease research laboratory test.

dissociation. On the other hand, nerve conduction study serum neuromyelitis optica and myelin oligodendrocyte
revealed pure motor involvement in both upper and lower glycoprotein antibody.
limbs, and magnetic resonance imaging (MRI) of the
brain and spine performed on January 11, 2022, revealed In view of less-than-satisfactory neurological recovery, she
minimal sub-arachnoid hemorrhage in left Sylvian fissure was further treated with pulse intravenous methylprednisolone
and long segment altered signal intensity from C6 to conus 1 g for 5 days during January 15–19, 2022, followed by oral
medullaris, which was suggestive of LETM. Figure 1 shows prednisolone taper. Hemodialysis treatment was indicated
an MRI image displaying LETM in cervico-dorsal cord. for her for 1 month since she had anuric acute kidney injury,
Further tests showed that the patient was negative for and her renal functions improved gradually over 1 month.

Volume 2 Issue 3 (2023) 3 https://doi.org/10.36922/gpd.1320