Cardiac MRI in Children with Multisystem Inflammatory Syndrome                     Associated with COVID-19

Blondiaux, Éléonore; Parisot, Pauline; Redheuil, Alban; Tzaroukian, Lucile; Levy, Yaël; Sileo, Chiara; Schnuriger, Aurélie; Lorrot, Mathie; Guedj, Romain; Pointe, Hubert Ducou Le

doi:10.1148/radiol.2020202288

Cited by 205 publications

(270 citation statements)

References 17 publications

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“…This showed normalized coronary artery caliber, and no evidence of myocardial inflammation or late gadolinium enhancement, which suggests that no scarring occurred. In keeping with these findings, a French case series of four cardiac MRIs in children with MIS-C related myocarditis showed diffuse myocardial edema on T2-STIR sequences and native-T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis, favouring post-infectious myocarditis in children and adolescents with COVID-19 [ 88 ].…”

Section: Resultsmentioning

confidence: 73%

Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)

Felsenstein

Willis

Lythgoe

et al. 2020

JCM

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The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen responsible for Coronavirus Disease 2019 (COVID-19). Whilst most children and young people develop mild symptoms, recent reports suggest a novel paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Case definition and classification are preliminary, treatment is empiric and disease-associated outcomes are unclear. Here, we report 29 patients with PIMS-TS who were diagnosed, admitted and treated in the English North West between March and June 2020. Consistent with patterns observed internationally, cases peaked approximately 4 weeks after the initial surge of COVID-19-like symptoms in the UK population. Clinical symptoms included fever (100%), skin rashes (72%), cardiovascular involvement (86%), conjunctivitis (62%) and respiratory involvement (21%). Some patients had clinical features partially resembling Kawasaki disease (KD), toxic shock syndrome and cytokine storm syndrome. Male gender (69%), black, Asian and other minority ethnicities (BAME, 59%) were over-represented. Immune modulating treatment was used in all, including intravenous immunoglobulin (IVIG), corticosteroids and cytokine blockers. Notably, 32% of patients treated with IVIG alone went into remission. The rest required additional treatment, usually corticosteroids, with the exception of two patients who were treated with TNF inhibition and IL-1 blockade, respectively. Another patient received IL-1 inhibition as primary therapy, with associated rapid and sustained remission. Randomized and prospective studies are needed to investigate efficacy and safety of treatment, especially as resources of IVIG may be depleted secondary to high demand during future waves of COVID-19.

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Section: Resultsmentioning

confidence: 73%

Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)

Felsenstein

Willis

Lythgoe

et al. 2020

JCM

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“…Interestingly, both presentations were quite similar, with acute abdominal pain and fever that led to a false diagnosis of appendicitis (and appendectomy) before the diagnosis of PIMS-TS was confirmed. Several studies have described this aberrant immune reaction to SARS-CoV-2 infection, with excessive inflammation leading to acute heart failure [ 27 , 28 , 29 , 30 , 31 , 32 ], which had previously been reported for other viruses, such as Coronavirus 229E [ 33 ].…”

Section: Discussionmentioning

confidence: 91%

“…Interestingly, a French pilot study evaluated cardiac Magnetic Resonance Imaging (MRI) in four patients with PIMS-TS. MRI indicated post-infectious myocarditis, showing diffuse myocardial edema, with no evidence of replacement fibrosis or focal necrosis, which is usually observed in acute viral myocarditis [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1–17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2–10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.

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“…We identified a total of 34 case series 3 , 6 , 7 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 and case reports 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 published between May and July 2020 that mention dermatologic findings in 736 unique children with MIS-C. Cutaneous manifestations were present in 417 of 736 patients (57%). Fifteen (44%) of these articles state “rash” as the sole descriptor of skin findings.…”

Section: Dermatologic Presentationmentioning

confidence: 99%

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

Brumfiel

DiLorenzo

Petronic‐Rosic

2021

Clinics in Dermatology

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Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. Skin findings are often present in these patients and while initially compared to Kawasaki disease, likely represent distinct phenomena and overall remain poorly characterized. In this retrospective review of 34 case reports and series, we identified cutaneous manifestations documented in 417 of 736 patients (57%) with MIS-C associated with COVID-19. “Rash” was the sole descriptor of skin findings in nearly half of patients. Case reports and smaller case series provided more detail, outlining a broad range of lesion morphologies (polymorphic, maculopapular, morbilliform, erythrodermic, urticarial, reticular, petechial, purpuric) in variable anatomic distribution. More thorough descriptions of dermatologic manifestations in patients with MIS-C are warranted to better characterize this syndrome, as they may lend important insight into pathogenic mechanisms of disease.

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Cardiac MRI in Children with Multisystem Inflammatory Syndrome Associated with COVID-19

Cited by 205 publications

References 17 publications

Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)

Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

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