Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú

Abstract

La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

Clinical characteristics of children with COVID-19 admitted in a tertiary referral center in Perú

“…An increase of CPR and Dimer-D was fundamentally observed in this study. In accordance to findings in literature, a variety of laboratory alterations have been described in COVID-19, especially in inflammatory serum markers (6, 15, 23, 24) a study found high levels of CPR, procalcitonin, interleukin-6, ferritin and Dimer-D in relation to severity (23). Our findings could have been explained by the elevated proportion of patients with mild symptoms, moderate and because only initial tests were included in the analysis.…”

“…In relation to MIS-C cases, 6 patients with MIS-C diagnostic were found and 2 required PICU admission similar to what was described in another Peruvian report (⅛) (24). Meanwhile, in another study MIS-C cases represented 5 time more probabilities of PICU admission, however, no MIS-C patient died (6).…”

“…Moreover, in a systematic review 7.8% of children received hydroxychloroquine, 4.1% corticosteroids and 3.1% immunoglobulin (15). Regarding hydroxychloroquine, the limited scientific evidence reported initially can explain the findings in comparison to intravenous immunoglobulin which is accepted as immunomodulatory therapy in the management of Kawasaki and MIS-C (6, 24, 27, 28).…”

Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

“…It is interesting that pediatric ADEM cases reported to date represent 30% of ADEM associated with COVID-19 (Table 2), which suggests that although it is a rare event, physicians should assess carefully neurological symptoms as part of the post-COVID-19 follow-up in children. Another point to highlight is that ADEM-like cases have been described in the context of an entity called MIS-C ( Abdel-Mannan et al, 2020 ; Lindan et al, 2020 ; Mehra et al, 2020 ) reported to appear between 10 and 54 days after COVID-19 infection ( Cheung et al, 2020 ; Coll-Vela et al, 2020 ; Toubiana et al, 2020 ; Verdoni et al, 2020 ; Whittaker et al, 2020 ). However, these MIS-C cases that have presented ADEM-like lesions do not have a confirmatory test for COVID-19 (they only have positive IgG serology) and were not considered in this review.…”

Síndrome inflamatorio multisistémico pediátrico asociado a COVID-19: reporte preliminar de un hospital del Perú

“…Un gran porcentaje ha requerido manejo por una unidad de cuidados intensivos (UCI) (2) . En el Perú existen varios centros que atienden el SIM-P, pero hasta el momento sólo se ha reportado una serie de casos de ocho pacientes (4) . Por lo tanto, con el objetivo de describir el perfil clínico-epidemiológico, mejorar su manejo, y disminuir su morbimortalidad; reportamos los resultados preliminares de 37 casos de SIM-P del Hospital Nacional Edgardo Rebagliati Martins (HNERM), en Lima, Perú, desde abril a agosto del 2020.…”