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

Abstract

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.

Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

“…When focusing on severe abdominal manifestations, we found nine patients affected by MIS-C who underwent exploratory laparotomies: two children with a healthy appendix as finding (“pseudo appendicular syndrome”) [ 16 , 17 ], one with aseptic peritonitis [ 18 ], four with appendicitis [ 19 ] and two with mesenteric lymphadenitis [ 20 ]. Appendicitis was initially suspected in roughly 5–30% [ 16 , 18 , [20] , [21] , [22] , [23] , [24] ] of the reviewed case series and in four case reports [ 9 , 17 , 25 , 26 ]. Three patients underwent intestinal resection with re-anastomosis due to segmental inflammation with necrosis of terminal ileum [ 9 , 17 , 27 ].…”

“…Several authors reported acute abdomen presentation in a not negligible number of patients. Our systematic review of literature evidenced acute abdomen presentation up to 30% [ 16 , 18 , [20] , [21] , [22] , [23] , [24] ]. It is attractive to speculate that vascular damage could probably play a role as well with this regard.…”

Plans to vaccinate children for COVID-19: a survey of US parents

“…[2][3][4][5][6] In addition, COVID-19 infection can lead to multi inflammatory syndrome in children (MIS C) and there is some evidence that children may experience long COVID with ongoing symptoms, including fatigue and pain. [7][8][9] Preventing COVID-19 in children is of critical importance and, to date, mask wearing and social distancing, including closing or reducing time at school, have been the primary approaches for infection control. 10,11 While no COVID-19 vaccines are yet approved for children <16 years of age, clinical trials in pediatric populations are underway.…”

Successful Treatment of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 (PIMS-TS) with Split Doses of Immunoglobulin G and Estimation of PIMS-TS Incidence in a County District in Southern Germany

“…Therefore, in case of fulfillment of other criteria necessary, diagnosis might be made more often. Since the first description of this syndrome, numerous cases have been published worldwide [ 16 , 17 , 18 ], sometimes leading to harmful disease or even death. Early recognition of this entity is important since early therapy can prevent a catastrophic course of the disease [ 17 ].…”