The clinical course and short-term health outcomes of multisystem inflammatory syndrome in children in the single pediatric rheumatology center

Abstract

Objectives Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition resulting in excessive response of the immune system after SARS-CoV-2 infection. We report a single-center cohort of children with MIS-C, describing the spectrum of presentation, therapies, clinical course, and short-term outcomes. Methods This is a prospective observational study from to a tertiary pediatric rheumatology center including patients (aged 1 month to 21 years) diagnosed with MIS-C between April 2020-April 2021. Demographic, clinical, laboratory results and follow-up data were collected through the electronic patient record system and analyzed. Results A total of 67 patients with MIS-C were included in the study. Fever was detected in all patients; gastrointestinal system symptoms were found in 67.2% of the patients, rash in 38.8%, conjunctivitis in 31.3%, hypotension in 26.9% myocarditis, and/or pericarditis in 22.4%, respectively. Respiratory symptoms were only in five patients (7.5%). Kawasaki Disease like presentation was found 37.3% of the patients. The mean duration of hospitalization was 11.8 7.07 days. Fifty-seven patients (85%) received intravenous immunoglobulin (IVIG), 45 (67%) received corticosteroids, 17 (25.3%) received anakinra, and one (1.5%) received tocilizumab. Seven of the patients (10.4%) underwent therapeutic plasma exchange (TPE). In 21 (31.3%) patients, a pediatric intensive care unit (PICU) was required in a median of 2 days. The first finding to improve was fever, while the first parameter to decrease was ferritin (median 6.5 days (IQR, 4–11.2 days)). Sixty-five patients were discharged home with a median duration of hospital stay of 10 days (IQR, 7–15 days). Conclusion Patients with MIS-C may have severe cardiac findings and intensive care requirements in admission and hospital follow-up. The vast majority of these findings improve with effective treatment without any sequelae until discharge and in a short time in follow-up. Although the pathogenesis and treatment plan of the disease are partially elucidated, follow-up studies are needed in terms of long-term prognosis and relapse probabilities.

Eastern India Collaboration on Multisystem Inflammatory Syndrome in Children (EICOMISC): A Multicenter Observational Study of 134 Cases

“…In our study, gastro-intestinal symptoms were observed in 50.37% cases, which was lower than that reported in other studies ( 13 , 25 , 26 ) but more than the Latin American study ( 24 ). The figure is still much lesser than that reported in the systematic review (85.6%) ( 12 ), which may be because of a larger sample size in the later.…”

“…This is in agreement with the epidemiology of MIS-C, which indicates that majority of the cases develop 4–6 weeks after exposure to the virus ( 27 ). In our study, 23.9% had underlying co-morbidities, whereas it was 38.7% in the previous Indian study ( 13 ), 28.35% in Turkish study ( 26 ), and 15.8% in the Latin American study ( 24 ).…”

“…In our study, rash was reported in 40% cases compared to 57.14% in the previous Indian study ( 12 ), 68% in the Brazilian study ( 25 ), and 54.9% in a systemic review ( 12 ). Our study reported a higher rate of non-purulent conjunctivitis (71%) compared to 25.8% in the Indian study ( 13 ), 31.3% in the Turkish study ( 26 ), and 49.8% reported in the systematic review ( 12 ).…”

“…Second most common were the respiratory symptoms (39.26%), which is similar to that reported in the Latin American study ( 24 ), but lower than that reported in the systematic review ( 12 ), the Brazilian study ( 25 ) and the previous Indian study (67.74%) ( 13 ). For unknown reason, the Turkish study reported a much lesser frequency of respiratory symptoms (7.4%) compared to all the studies ( 26 ).…”

“…CAAs were seen in 10.45% of our cases, which was similar to that reported in the systematic review ( 12 ). Lowest incidence of CAAs was reported in the Turkish study (6.45%) ( 26 ), and highest in the Brazilian study (27%) ( 25 ). The later figures may correspond to the incidence of Kawasaki disease (KD) in these countries, as KD and MIS-C probably share similar patho-physiologic mechanisms ( 29 ).…”