COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

Abstract

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar. Methods: Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed.Results: The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70%-100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors.Conclusions: Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.

COVID-19 Related Multisystem Inflammatory Syndrome in Children: A Case Series from a Tertiary Hospital in Riyadh, Saudi Arabia

“…A history of COVID-19 exposure or infection based on PCR results led to an early suspicion of MIS-C for most Antibody serology testing was helpful in determining the COVID-19 infection status in three cases where PCR results were previously negative. Overall, most of our patients had positive COVID-19 PCR results (62.5%), which was similar to the ≥50% positive COVID-19 PCR results reported in other studies [14] [16] [17]. The remaining three patients who tested positive for SARS-CoV-2 antibodies by serological testing at the time of presentation supported the postinfectious nature of the disease [18].…”

“…Although most patients in our case series required inotropic support either to maintain blood pressure not responding to fluids or cardiac contractility, only two had transient left ventricular dysfunction that recovered quickly, in contrasts with patients with KD who rarely present with hemodynamic instability. Similar results have been reported in Qatar and Saudi Arabia [7] [13] [14]. Elevated troponin levels have previously been linked to poor outcomes in patients with COVID-19 and may indicate the degree of systemic inflammation and myocardial damage [23].…”

“…Most of our patients responded effectively to intravenous immunoglobulin (IVIG) plus IV corticosteroids in terms of fever reduction and fewer requirements for inotropic support. In contrast, a study in Qatar found that two individuals required an IL-1 inhibitor because they had ARDS and coronary artery disease aneurysm [14].…”

“…This highlights the need for cardiac evaluation using echocardiography at the time of diagnosis and at frequent intervals in accordance with KD treatment [7] [22]. It has been shown that up to 56% of patients with MIS-C have decreased ventricular function, with EF being the most prevalent cardiac abnormality found in these individuals, at 55% [19] [22]; however, KD has a lower proclivity for substantial ventricular dysfunction [14]. Although most patients in our case series required inotropic support either to maintain blood pressure not responding to fluids or cardiac contractility, only two had transient left ventricular dysfunction that recovered quickly, in contrasts with patients with KD who rarely present with hemodynamic instability.…”

Hospitalized children with SARS-CoV-2 infection and MIS-C in Jamaica: A dive into the first 15 months of the novel pandemic

“…In the USA, 51.0% received vasopressors and 15.0% mechanical ventilation in New York, and a national surveillance study in the US of children with MIS-C reported 45.1% had shock and required vasopressors and 9.4% required invasive ventilation over the first three waves of the pandemic (33,34). While a pediatric case series in Qatar reported 71.4% requiring inotropes while in intensive care (35). In the developing world, reports from Mexico and Pakistan reported 23 and 25% of children with MIS-C in shock, respectively (36,37).…”