Who Would Have Predicted Multisystem Inflammatory Syndrome in Children?

Abstract

Purpose of Review Multisystem inflammatory disease in children (MIS-C) is a novel post-infectious phenomenon following coronavirus disease-19 . Herein, we present an in-depth review of the latest MIS-C literature related to clinical findings, pathophysiology, imaging and laboratory studies, treatment algorithms, and disease outcomes.Recent Findings With its non-specific presentation of fever, gastrointestinal symptoms, cardiovascular injury and shock, systemic inflammation, and Kawasaki disease (KD)-like features, MIS-C can be a diagnostic challenge, overlapping with KD and active COVID-19 infection. However, common laboratory features, imaging findings, and historical clues can lead to accurate diagnosis and allow for appropriate treatment with a variety of immunomodulatory therapies, including intravenous immunoglobulin (IVIG). Aggressive treatment of MIS-C leads to good outcomes. Longitudinal studies continue to illuminate long-term cardiac sequelae and recovery. Summary MIS-C presents with fever, KD features, gastrointestinal symptoms, cardiac inflammation, and shock. Early recognition and prompt institution of IVIG and glucocorticoids provide for rapid improvement.

Biologic disease-modifying antirheumatic drugs to treat multisystem inflammatory syndrome in children

“…The clinical and laboratory features of CSS were present in studied cohorts of children with MIS-C; however, the severity of many of the laboratory features detected in the blood did not reach the extent of elevation as seen in more traditional CSS, like macrophage activation syndrome (MAS) [7,36]. While markers of CSS/MAS, including sCD25, ferritin, IL-18, and CXCL9 (indirect correlate with interferon-gamma (IFNγ)), were elevated in children with MIS-C, the degree of elevation was typically a log or more less than detected in children with other causes of CSS/MAS [9 ▪▪ ].…”

“…pediatric multisystem inflammatory syndrome or PMIS; multisystem inflammatory syndrome in children or MIS-C), it appeared to be largely restricted to previously healthy children and a few young adults (MIS-A) [6]. Definitions for MIS-C were established early on, and the United States Centers for Disease Control and Prevention (CDC) definition was as follows: under 21 years of age, fever, laboratory evidence of inflammation, severity requiring hospitalization, with multisystem (>2) organ involvement (cardiac, kidney, respiratory, hematologic, gastrointestinal, dermatologic, or neurologic) and no alternative plausible diagnoses and positive for current or recent SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR), serology, or antigen test; or COVID-19 exposure within 4 weeks of symptom onset [3 ▪▪ ,7].…”

Nutritional Sensor REDD1 in Cancer and Inflammation: Friend or Foe?

“…However, prolonged REDD1 overexpression prevents cell differentiation, positively affects the malignant tumor development, and plays a pro-inflammatory role. Gcs are widely used in the therapy of blood cancer and numerous inflammatory diseases, including psoriasis, eczema, rheumatoid arthritis, asthma, systemic lupus erythematosus, inflammatory bowel disease, and COVID-19-associated multisystem inflammatory syndrome [ 31 , 117 , 118 , 119 ]. Genetic or pharmacological inhibition of REDD1, one of the direct GR target genes, protected skin and muscle against atrophy but did not significantly influence the anti-inflammatory effect of Gcs [ 8 , 26 , 28 , 40 , 120 , 121 ].…”

Complications of severe acute respiratory syndrome coronavirus 2 infection in children

“…Over the last year and half, there has been an increasing number of reports of MIS-C and much has been learned about this condition [6 ▪▪ –8 ▪▪ ,9 ▪ ,10 ▪ ]. In the largest study of 1733 patients, its incidence has been estimated to be 2.1 cases per 100 000 children [8 ▪▪ ].…”