Multisystem Inflammatory Syndrome in Children: Experience from October 2020 to January 2021 at a Tertiary Hospital in Navi Mumbai, India

Abstract

Although presentation of multisystem inflammatory syndrome (MIS-C) in children is typically with fever and symptoms like diarrhea, vomiting, rash, conjunctival injection, or shock, the spectrum of associated multisystem involvement is wide. Here, we present an account of patients with MIS-C that presented at a tertiary hospital in Navi Mumbai, India in the latter half of the pandemic from October 2020 to January 2021. We retrospectively studied the clinical features of 12 patients satisfying World Health Organization criteria for MIS-C. Eleven (91.6%) required PICU admission. Median age was 7 years and two had comorbidity. At the time of presentation, eight (66.6%) had respiratory failure, four (33.3%) had shock, and one (8.3%) had renal failure. The most common system involved was respiratory (75%) followed by mucocutaneous manifestations (66.6%). Seven patients (58.3%) showed involvement of >4 systems. Atypical presentations included a 14-year-old male with COVID-19 like pulmonary involvement on computed tomography, and a 20-month-old male with gross hematuria, nephrotic range proteinuria, and rapidly progressive renal failure. Elevated N-terminal-pro B-type natriuretic peptide was seen in 75% patients and abnormal two-dimensional echo in 50%. All patients were treated with intravenous methylprednisolone at 30 mg/kg/day for 5 days. Death occurred in three (25%), all of whom had hypotensive shock at presentation. In the wake of an ongoing pandemic, any febrile child with nonspecific symptoms suggestive of multisystem involvement warrants suspicion of MIS-C and should be evaluated with the help of markers of systemic inflammation and organ involvement, after ruling out other obvious causes. We report good response to methylprednisolone in patients without hypotensive shock at presentation and its use as firstline drug may be considered in settings with financial constraints.