Gastrointestinal Involvements in Children With COVID-related Multisystem Inflammatory Syndrome

Chen, Tai‐Heng; Kao, Wei-Tsun; Tseng, Yung-Hao

doi:10.1053/j.gastro.2020.06.084

Cited by 14 publications

(17 citation statements)

References 7 publications

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“…While existing research has indicated that 10% of MIS-C cases had rare presentations mimicking acute appendicitis and peritonitis, the high incidence of GI involvement in MIS-C cases still remains unclear. 11 It is noteworthy that two of the six currently reported patients presented with an acute surgical abdomen denoting the broad clinical manifestations of this condition. Studies have shown that MIS-C can lead to multi-organ failure requiring intensive care with 44-80% of patients needing admission to the PICU.…”

Section: Discussionmentioning

confidence: 93%

“…Treatment procedures for these patients included inotropic support (47%) and invasive ventilation (20-43%). 4,10,11 Cardiac involvement in this condition typically included impairment in ventricular ejection, pericardial effusion and other coronary abnormalities. 7,10 Five of the patients in the current case series required PICU admission with three of them requiring inotropic and respiratory support.…”

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2-related Multisystem Inflammatory Syndrome in Children

Maskari

Mukhaini

Abrawi

et al. 2021

Sultan Qaboos Univ Med J

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On 27 April 2020, the National Health Service England issued an emergency alert for a new condition owing to the observation of an increasing number of cases of a COVID-19-related hyperinflammatory syndrome termed multisystem inflammatory syndrome in children (MIS-C). Some of the presenting symptoms appeared similar to the Kawasaki disease and toxic shock syndrome. We report the cases of six children fitting the criteria of MIS-C, admitted to Royal Hospital and Sohar Hospital, Oman, between the months of June and July in 2020. Four of these patients required admission at the paediatric intensive care unit for inotropic support while two were admitted to the paediatric ward on suspicion of appendicitis. MIS-C has been reported in a small number of individuals below the age of 21 years with a median age of 9–10 years. Five of the current patients were aged less than the median age reported in the existing literature. All of the patients showed complete recovery with supportive management, intravenous immunoglobulin and steroids, with one patient requiring interleukin-6 inhibitor (tocilizumab). Keywords: COVID-19; SARS-CoV-2; Kawasaki Disease; Multisystem Inflammatory Syndrome in Children; Toxic Shock Syndrome; Case Report; Oman.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2-related Multisystem Inflammatory Syndrome in Children

Maskari

Mukhaini

Abrawi

et al. 2021

Sultan Qaboos Univ Med J

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“…In [69] was similar to that of this study, and the gastrointestinal symptoms were often abdominal pain. When exploratory abdominal surgery was performed under MIS-C, gastrointestinal investigations also showed mesenteric lymphadenitis and serous effusions (ascites) in severe cases, which implied an active inflammatory reaction had occurred in the digestive system [70]. However, it has been proven that angiotensin-converting enzyme 2 is highly expressed in the small intestine, especially in the proximal and distal intestinal epithelial cells, so the small intestine is more vulnerable to SARS-CoV-2 infection [71].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease 2019-Related Multisystem Inflammatory Syndrome in Children: A Systematic Review and Meta-Analysis

Wang

Zhong

et al. 2021

Biochemistry Research International

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Background. This study aimed to describe the clinical symptoms, laboratory findings, treatment, and outcomes of coronavirus disease 2019-related multisystem inflammatory syndrome in children to provide a reference for clinical practice. Methods. We employed a literature search of databases such as PubMed, Web of Science, EMBASE, and Johns Hopkins University for articles on COVID-19-related multisystem inflammatory syndrome in children published between April 1, 2020, and January 15, 2021. High-quality articles were selected for analysis on the basis of their quality standard scores. Using R3.6.3 software, meta-analyses of random- or fixed-effects models were used to determine the prevalence of comorbidities. Subgroup analysis was also performed to determine heterogeneity. Results. A total of 57 articles (2,290 pediatric patients) were included in the study. Clinical Manifestations. :ncidences of fever, gastrointestinal symptoms, respiratory symptoms, and musculoskeletal symptoms (myalgias or arthralgias) were 99.91% (95% CI: 99.67–100%), 82.72% (95% CI: 78.19–86.81%), 53.02% (45.28–60.68%), and 14.16% (95% CI: 8.4–21.12%), respectively. The incidences of rash, conjunctival injection, lymphadenopathy, dry cracked lips, neurologic symptoms (headache, altered mental status, or confusion), swollen hands and feet, typical Kawasaki disease, and atypical Kawasaki disease were 59.34% (95% CI: 54.73–63.87%), 55.23% (95% CI: 50.22–60.19%), 27.07% (95% CI: 19.87–34.93%), 46.37% (95% CI: 39.97–52.83%), 28.87% (95% CI: 22.76–35.40%), 28.75% (95% CI: 21.46–36.64%), 17.32% (95% CI: 15.44–19.29%), and 36.19% (95% CI: 21.90–51.86%), respectively. The incidences of coronary artery dilation, aneurysm, pericardial effusion, myocarditis, myocardial dysfunction, high troponin, and N-terminal pro-B-type natriuretic peptide were 17.83%, 6.85%, 20.97%, 35.97%, 56.32%, 76.34%, and 86.65%, respectively. The incidences of reduced lymphocytes, thrombocytopenia, hypoalbuminemia, elevated C-reactive protein, ferritin, LDH, interleukin-6, PCT, and FIB were 61.51%, 26.42%, 77.92%, 98.5%, 86.79%, 80.59%, 89.30%, 85.10%, and 87.01%, respectively. PICU Hospitalization Rate and Mortality. The incidences of PICU hospitalization or with shock were 72.79% and 55.68%, respectively. The mortality rate was 1.00%. Conclusion and Relevance. PICU hospitalization and shock rates of multisystem inflammatory syndrome in children associated with COVID-19 were high, and its cumulative multiorgans and inflammatory indicators are increased, but if treated in time, the mortality rate was low.

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“…It has been reported that approximately 10–30% of cases of MIS-C can mimic symptoms of appendicitis or acute peritonitis, in this report 23% of a 34-patient cohort with MIS-C was documented [ 16 ]. Gastrointestinal manifestations are frequent and of very varied presentation [ 8 , 11 ].…”

Section: Discussionmentioning

confidence: 91%

“…In other series, there has been a wrong diagnosis of appendicitis due to suggestive symptoms of surgical abdomen [ 6 , 10 ]. It is important to carefully evaluate each case of MIS-C to identify those that may require operation and avoid unnecessary procedures in those cases that become a clinical challenge [ 2 , 3 , 7 , 8 , 16 ]. Given the evolution of the pandemic, some groups of health professionals have chosen conservative management of suspected cases of acute appendicitis, by administering antibiotics and even home care [ 14 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Abdominal manifestation of multisystemic inflammatory syndrome in children

Gómez¹,

López²,

Duque

et al. 2021

Journal of Pediatric Surgery Case Reports

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Summary Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury. Method ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management. Results The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis. Conclusions patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.

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Gastrointestinal Involvements in Children With COVID-related Multisystem Inflammatory Syndrome

Cited by 14 publications

References 7 publications

SARS-CoV-2-related Multisystem Inflammatory Syndrome in Children

SARS-CoV-2-related Multisystem Inflammatory Syndrome in Children

Coronavirus Disease 2019-Related Multisystem Inflammatory Syndrome in Children: A Systematic Review and Meta-Analysis

Abdominal manifestation of multisystemic inflammatory syndrome in children

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