Researchers presented the case of a newborn who was diagnosed simultaneously with severe hemophilia A and multisystem inflammatory syndrome (MIS) and published their results in BMC Pediatrics.

A 2-day-old male infant presented with left thigh swelling, fatigue, and poor feeding. The patient required intubation due to apnea. Upon examination, physicians found that the baby had bulging anterior fontanelle, anisocoria, and a bluish swelling on the left thigh at the site of vitamin K injection measuring 3 cm x 1 cm. In addition, the infant had tonic seizures on all 4 limbs.

Laboratory findings revealed hemoglobin levels of 12.8 g/dL and C-reactive protein of 13 mg/L. The patient had normal prothrombin time and isolated activated partial thromboplastin time prolongation. In addition, a neurosonogram revealed an 8 mm subdural hemorrhage in the left frontotemporal region.


Continue Reading

Factor VIII (FVIII) activity was found to be less than 1% and the patient was diagnosed with hemophilia A. He was transfused with packed red cells and fresh frozen plasma. His physicians started him on FVIII transfusions of 125 IU twice a day, antibiotics, and anticonvulsants.

“Considering an antenatal history of maternal SARS-CoV-2 at 32 weeks of gestation, the baby was evaluated for [neonatal MIS],” the authors of the study wrote. “Anti SARS-CoV-2 IgG antibody test was positive in the baby.” 

Read more about hemophilia comorbidities 

In addition, the patient had elevated inflammatory markers. His physicians prescribed him intravenous immunoglobulin of 1 g/kg for 2 days and methylprednisolone of 1 mg/kg every 12 hours for 6 days and tapered over 4 days. 

On day 6, the infant was extubated. Inflammatory markers were reduced, and FVIII was continued targeting 100% levels. His intracranial bleed was managed by the neurosurgery team conservatively.

On day 16, the patient developed seizures and a magnetic resonance imaging scan demonstrated increased bilateral subdural hemorrhage with a midline shift to right. Due to characteristics suggestive of brain injury, communicating hydrocephalus, and progression of intracranial bleed, he had a left parietal craniostomy with subdural hematoma evacuation. He was prescribed phenytoin and levetiracetam for his seizures postoperation.

“The baby is now 2-months old and thriving on breast milk alone,” the authors said. “He is on [FVIII] replacement, is seizure-free on levetiracetam, and is currently under neurodevelopmental follow-up.”

Reference

Arun S, Cherian TG, Philip C. Multisystem inflammatory syndrome in a neonate with severe hemophilia – a diagnostic challenge in COVID times: a case reportBMC Pediatr. 2022;22(1):397. doi:10.1186/s12887-022-03463-3