Three Cases of Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19 Due to SARS-CoV-2

Abstract

Case series Patients: Male, 7-year-old • Female, 6-year-old • Male, 5-year-old Final Diagnosis: Multisystem inflammatory syndrome in children (MIS-C) Symptoms: Heart failure Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology Objective: Unusual clinical course Background: Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. Case Reports: Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorpo-real membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered. Conclusions: Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO.

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… N.A. [ 213 ] 1 (non-confirmed) F 7 PIMS-TS IVIg, glucocorticoids, ASA Recovered [ 214 ] 3 (2 confirmed) 2 M 1 F 6y PIMS-TS 2 shock IVIg, ASA Recovered [ 215 ] 570 (565 confirmed) 316 M 254 F 8y MIS-C 202 shock 424 IVIg, 331 glucocorticoids, 309 ASA 10 Deaths 95 Coronary artery abnormalities [ 216 ] 30 (2 confirmed) 12 M 2 F 2y 22 complete KD, 8 atypical KD 30 IVIg, 14 IVIg + glucocorticoids, Recovered 2 Coronary artery aneurysms [ 217 ] 25 (17 confirmed) 15 M 10 F 12.5y MIS-C 23 IVIg, 20 glucocorticoids, 10 TCZ, 4 infliximab, 1 anakinra Recovered 7 Coronary artery abnormalities [ 218 ] 11 (all confirmed) 9 M 2 F 59m PIMS-TS, 5 shock N.A. 2 Deaths [ 219 ] 1 (confirmed) M 45y KD IVIg, TCZ, topical glucocorticoids Recovered [ …”

Coronavirus global pandemic: An overview of current findings among pediatric patients

“…Levels of many cytokines have been found to be increased in severe, critically ill and fatal cases 14,22,156,166,171 . Of note, there are emerging reports of a rare systemic inflammatory condition in children, resembling typical or atypical Kawasaki disease, presently named Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS‐CoV‐2 infection (PIMS‐TS), toxic shock syndromes, bacterial sepsis and macrophage activation syndromes (http://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19) 77,106,107,111,114,203,209‐229 of whom some but not all test positive for COVID‐19. The clinical characteristics of PIMS‐TS include cardiac disease sometimes including coronary artery aneurysms, the need for intensive care and inotrope, and additional treatments.…”

Kawasaki or Kawasaki-like disease? A debate on COVID-19 infection in children

“…Lymphocytopenia was observed in 7 patient and lymphocytosis in one patient. Heidemann et al (USA) [ 9 ] 3 3 6 (5y-7y) 1:2 1 Prolonged fever was observed in 2 of 3 patients. Echocardiography showed decreased left ventricular function in all patients.…”