Multi-system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia

Abstract

Most of the reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children reported mild-to-moderate disease manifestations. However, recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS-CoV-2 infection termed multisystem inflammatory syndrome in children (MIS-C). The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS-C associated with SARS-CoV-2 infection. They were admitted to the pediatric intensive care unit (PICU). Their clinical presentation, laboratory, and outcome were described. All patients shared similar clinical presentations such as persistent documented fever for more than 3 days, respiratory symptoms, gastrointestinal involvement, and increased inflammatory markers (CRP, ESR, and ferritin). Three patients had concurrent positive coronavirus disease 2019 (COVID-19) infection, and the other 2 patients had contact with suspected COVID-19 positive patients. They were all managed in the PICU and received intravenous immunoglobulin, systemic steroid, and hydroxychloroquine. The hospital stays ranged between 3 and 21 days. One patient died due to severe multiorgan failures and shock, and the other 4 patients were discharged with good conditions. Pediatric patients with SARS–CoV-2 are at risk for MIS-C. MIS-C has a spectrum of clinical and laboratory presentations, and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes. Long-term follow-up studies will be required to explore any sequelae of MIS-C, precisely the cardiovascular complications.

An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

“…This is the first case report of multisystem inflammatory syndrome in children (MIS-C) in Saudi Arabia involving coronary artery aneurysm, left ventricular dysfunction, hyperinflammation, and multiorgan damage associated with SARS-CoV-2 infection. Rapid clinical deterioration has been shown in most studies as a cardinal feature, associated with shock, poor capillary refilling times, and skin rashes, and necessitating fluid bolus administration followed by inotrope support, as in our case [ 15 – 17 , 24 ] In fact, shock is either cardiogenic or distributive in nature [ 28 , 29 ]. de Lama Caro-Paton published a case series in a pediatric intensive care unit in Madrid, Spain, with 12 patients with MIS-C ages 5–14 years old.…”

“…A similar echocardio-graphic finding was noted in more than half of MIS-C cases with coronary artery ectasia rather than aneurysm [ 16 ]. Further, a few published case reports indicated no coronary lesion [ 17 – 19 ]. We believe this to be the first reported case of coronary artery aneurysm associated with MIS-C in Saudi Arabia.…”

A case report of pediatric systemic lupus erythematosus with diffuse alveolar hemorrhage following COVID-19 infection: Causation, association, or chance?

“…[ 20 , 21 ] Several publications have reported autoinflammatory and autoimmune illnesses in patients who have recovered from COVID-19. [ 14 , 16 , 17 , 25 ]…”

“…[12,13] Since the beginning of the COVID-19 pandemic, several reports have linked previous or concurrent COVID-19 infections to a high prevalence of autoimmune and autoinflammatory disorders. [9,[14][15][16] Recently, an adult SLE case report has been reported following severe COVID-19 infection. [9] In addition, Gracia-Ramos et al [17] recently published a comprehensive review of the emergence of autoimmune diseases during the COVID-19 pandemic, concluding that some autoimmune diseases are associated with COVID-19 infection.…”

Severe Multi-inflammatory Syndrome in Children Temporally Related to COVID 19—Clinical Course, Laboratory Profile and Outcomes from a North Indian PICU

“…The mortality in children with COVID infection has been observed to be low (0.09%), 31 however, in MIS-C, it ranges between 1.7–11%. 2,24,26,31,32 Asseri et al 33 detailed in their series, the catastrophic course of one of the cases, wherein, the patient developed a downhill course despite rapid escalation of care and first line agents—IvIg and steroids. We experienced a similar precipitous deterioration in four cases within 48 hours of admission with multi organ dysfunction, catecholamine refractory shock, oxygenation index >15 and indication for extra-corporeal therapy (Figure 4a–d).…”