Varying Presentations of Multisystem Inflammatory Syndrome Temporarily Associated with COVID-19

Abstract

Background. A novel coronavirus identified in 2019 leads to a pandemic of severe acute respiratory distress syndrome with important morbidity and mortality. Initially, children seemed minimally affected, but there were reports of cases similar to (atypical) Kawasaki disease or toxic shock syndrome, and evidence emerges about a complication named paediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C). Case Presentations. Two cases were compared and discussed demonstrating varying presentations, management, and evolution of MIS-C. These cases are presented to increase awareness and familiarity among paediatricians and emergency physicians with the different clinical manifestations of this syndrome. Discussion. MIS-C may occur with possible diverse clinical presentations. Early recognition and treatment are paramount for a beneficial outcome.

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

“…We report a single-center experience of three children and adolescents presenting with PIMS-TS, treated with serial immunoglobulins and high-dose oral acetyl salicylic acid with good short-term outcome, in accordance with previously published reports [ 11 , 12 ]. A recent report stated that, in children with Kawasaki disease over 25 kg body weight, dosage of immunoglobulin could be reduced to 1 gr/kg BW without difference in outcome [ 13 ].…”

Atypical Head and Neck Phlegmons as an Early Indicator to MIS‐C in the Pediatric Population

“…Multisystem inflammatory syndrome in children (MIS‐C) is an uncommon, severe, sequela of pediatric COVID‐19 infection. World Health Organization MIS‐C diagnostic criteria includes the presence of fever, multisystem involvement, and evidence of prior COVID‐19 infection/exposure 3,4 . The presumed pathophysiology are cellular‐level changes analogous to Kawasaki disease 5 .…”

“…World Health Organization MIS-C diagnostic criteria includes the presence of fever, multisystem involvement, and evidence of prior COVID-19 infection/exposure. 3,4 The presumed pathophysiology are cellular-level changes analogous to Kawasaki disease. 5 We present two previously healthy, prevaccination era patients with atypical head and neck phlegmons presumed to be deep neck space infections, found to be initial presentations of MIS-C. Children's Healthcare of Atlanta Institutional Review Board exemption was obtained.…”