A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease

Abstract

The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4–11] vs. 3 [IQR 1–4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae—mainly cardiovascular—were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

“…KD is associated with CAL and long-term cardiovascular sequelae, while MIS-C presents as more intense Inflammatory Syndrome, myocardial dysfunction, and cardiogenic shock [ 124 ]. In a retrospective review of 395 MIS-C and 69 KD patients, MIS-C patients presented with gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) symptoms, while KD patients presented with dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), and cervical lymph node swelling (51% vs. 34%) [ 125 ]. Additional MIS-X symptoms may derive from ongoing SARS-CoV-2 infections and differences in the age demographics for current cases.…”

Comparison of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome: case reports and literature review

“…Most patients with MIS-C show KD-related features, gastrointestinal problems, and hypotension, as did our two patients in this study. The presence of KD-related features in patients with MIS-C has received clinical attention, but the extent of organ dysfunction in patients with MIS-C is of greater importance as it directly affects the disease course and outcome [ 4 , 13 ]. In children and in adults, MIS can occur as a serious post-infectious complication of COVID-19.…”

“…On the contrary, it has been proposed that MIS-C and KDSS have a common host immune response and are of a single disease spectrum with varying severity [ 13 ]. Regardless of whether MIS-C and KDSS are the same disease entity, at least phenotypically, MIS-C and KDSS share many overlapping features [ 3 , 4 ]. We found that the most important factor that differentiates MIS-C from KDSS is whether SARS-CoV-2 has been identified as an infectious trigger.…”

“…With dermatologic involvement, many patients with MIS-C present with ‘Kawasaki disease (KD)-related features’ that constitute the diagnostic criteria for KD [ 3 ]. Accordingly, comparing the clinical and laboratory features of MIS-C and KD has become an important research topic during the COVID-19 pandemic [ 3 , 4 ].…”

Long-Term Microvascular Changes in Multisystem Inflammatory Syndrome in Children

“…Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe postinfection reaction to SARS-CoV-2 requiring intensive care treatment in 48% of patients . The precise pathogenesis and long-term clinical impact of MIS-C remain poorly understood.…”