Abstract
This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children’s Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)-like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered.Conclusion: MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) manifestations include fever, gastrointestinal symptoms, shock, and occasional features of Kawasaki disease (KD). • Treatment includes immunomodulatory agents, most commonly IVIG and corticosteroids. What is New: • Spectrum of MIS-C varies from mild to severe inflammation and coronary artery dilatation occurred in 5/22 (23%) critically ill patients. • IVIG and infliximab therapy were associated with a favorable outcome including resolution of coronary dilatation; only 2/33 received corticosteroids.
Keywords: COVID-19; IVIG; Infliximab; Kawasaki disease; MIS-C.
【저자키워드】 COVID-19, IVIG, MIS-C, Kawasaki disease, infliximab, 【초록키워드】 Inflammation, Corticosteroids, therapy, Critical care, children, Diagnosis, outcome, MIS-C, Shock, Immunoglobulin, management, Hypotension, Fever, Patient, Pain, Mild, Manifestations, Follow-up, Spectrum, Care, critically ill patients, Immunomodulatory agents, gastrointestinal symptoms, Inflammatory, manifestation, Myocardial dysfunction, medical record, clinical manifestation, Detroit, Older, overlap, syndrome, severe inflammation, inflammatory process, Myocardial, feature, occurred, include, required, conducted, median, characterized, less, resolved, children with MIS-C, 【제목키워드】 Treatment, Inflammatory, clinical manifestation, syndrome,