Case Series of Multisystem Inflammatory Syndrome (MIS-C) in Children during the SARS-CoV-2 Pandemic in Latvia

Abstract

The total number of COVID-19 positive cases in Latvia has escalated rapidly since October 2020, peaking in late December 2020 and early January 2021. Children generally develop COVID-19 more mildly than adults; however, it can be complicated by multisystem inflammatory syndrome in children (MIS-C). This case study aims were to assess demographic characteristics and the underlying medical conditions, and clinical, investigative and treatment data among 13 MIS-C patients using electronic medical records. All 13 had acute illness or contact with someone who was COVID-19 positive two to six weeks before MIS-C onset. Only five of the 13 were symptomatic during the acute COVID-19 phase. The median age was 8.8 years; 11/13 patients were male, 10/13 had been previously healthy, and all 13 patients tested positive for SARS-CoV-2 by RT-PCR or antibody testing. The most commonly involved organ systems were the gastrointestinal (13/13), hematologic (13/13), cardiovascular (13/13), skin and mucosa (13/13), and respiratory (12/13) ones. The median hospital stay was 13 (interquartile range, 11 to 18) days; 7/13 patients received intensive care, 6/13 oxygen support, and 5/13 received inotropic support. No deaths occurred. During the current pandemic, every child with a fever should have a clearly defined epidemiological history of COVID-19, a careful clinical assessment of possible multiple organ-system involvement, with a special focus on children with severe abdominal pain and/or skin and mucocutaneous lesions.

MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management

“…Respiratory symptoms were rare, usually presenting with cough or dyspnea [8,9,42,43,46,47,49,51,54,57,60,62,69], or rhinorrhea [42]. Cardiac dysfunction [6, 29,43,71] was seen, with chest pain [9, 50] on presentation, myocarditis [8,43], and coronary artery dilatation/ aneurysm [43]. Ophthalmic examination described by Verkuil et al [54] showed right-eye abduction deficit, consistent with abducens palsy.…”

“…Major treatment modalities were IVIG [6, 8, 28, 29, 40-46, 48-50, 52, 53, 55-63, 66-69, 72, 73], steroids [6, 8, 28, 29, 40-42, 44, 48, 49, 52, 59-61, 72, 73] like prednisolone [53,62], methylprednisolone [45,46,50,56,57,60,66,67], hydrocortisone [53,58], or dexamethasone [55], antiplatelet medications [6, 41,54] such as aspirin [43-45, 55, 58-61, 63, 66], and clopidogrel [45], and anticoagulation medications [6, 41,50,60] like enoxaparin [9, 41,47,50,56,58,67,70]. Vasoactive [6,9,40,47,54] and ionotropic agents [30,45,56,61] such as norepinephrine [41], dopamine [64,74], and milrinone [41,44,74] were added to treatment regimens when indicated. In a study by Greene A.G. et al, vitamin K [41] was indicated as well.…”

“…In a study by Greene A.G. et al, vitamin K [41] was indicated as well. Other medications which were given included volume expanders (IV fluids) [30,50,70], diuretics [61] such as furosemide [41], IV albumin [44], hydroxychloroquine [56,58,62,70], blood transfusion for anemia [69], anti-arrhythmic therapy, such as amiodarone [50], anti-interleukin-6 medication tocilizumab [9, 40-42, 47, 49, 56, 70, 74], interleukin 1 receptor antagonist anakinra [8, 29, 45-47, 50, 51, 58, 60, 61, 73], SARS-CoV-2 convalescent plasma transfusion [9, 41,42], anti-viral drugs like remdesivir [41,42,45,70], and Favipiravir [47,58], and TNF-α inhibitor infliximab [29,49,70].…”

“…Those with hypoxia were given supportive oxygen therapy [53,61,64,74] usually with high flow nasal cannula [44,46]. Patients progressing to respiratory distress required mechanical ventilation [9, 30,40,42,49,53,54,60,64,72] either by non-invasive positive pressure [74] or invasive methods and/or placement on ECMO [42,47,64,72].…”

“…A case in a study by Riollano-Cruz et al, with cardiogenic shock was treated with an intra-aortic balloon pump [9]. Many cases warranted either ward [9] or ICU admission [9, 40,53,61,62].…”