Clinical characteristics of 10 children with a pediatric inflammatory multisystem syndrome associated with COVID-19 in Iran

Abstract

Background Although symptoms and signs of COVID-19 (Coronavirus disease 2019) in children are milder than adults, there are reports of more severe cases which were defined as pediatric inflammatory multisystem syndrome (PIMS). The purpose of this report was to describe the possible association between COVID-19 and PIMS in children. Methods From 28 March to 24 June 2020, 10 febrile children were admitted with COVID-19 infection showing characteristics of PIMS in Buali tertiary hospital of Sari, in Mazandaran province, northern Iran. Demographic and clinical characteristics, laboratory and imaging findings, and therapeutic modalities were recorded and analyzed. Results The mean age of the patients was 5.37 ± 3.9 years (13 months to 12 years). Six of them were boys. Kawasaki disease, myocarditis, toxic shock syndrome, appendicitis, sepsis, urosepsis, prolonged febrile seizure, acute hemorrhagic edema of infancy, and COVID-19-related pneumonia were their first presentation. All of them had increased C-reactive protein levels, and most of them had elevated erythrocyte sedimentation rate, lymphopenia, anemia, and hypoalbuminemia. Three of them had thrombocytopenia(PLT < 106). Six of them were serologically or polymerase chain reaction positive for COVID-19, and 4 of them were diagnosed as COVID-19 just by chest computed tomography scan. Most of the patients improved without a residual sequel, except one who died with multiorgan failure and another case was discharged with a giant coronary aneurysm. Conclusions Children with COVID-19 may present symptoms similar to Kawasaki disease and inflammatory syndromes. PIMS should be considered in children with fever, rash, seizure, cough, tachypnea, and gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain.

Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

“…When focusing on severe abdominal manifestations, we found nine patients affected by MIS-C who underwent exploratory laparotomies: two children with a healthy appendix as finding (“pseudo appendicular syndrome”) [ 16 , 17 ], one with aseptic peritonitis [ 18 ], four with appendicitis [ 19 ] and two with mesenteric lymphadenitis [ 20 ]. Appendicitis was initially suspected in roughly 5–30% [ 16 , 18 , [20] , [21] , [22] , [23] , [24] ] of the reviewed case series and in four case reports [ 9 , 17 , 25 , 26 ]. Three patients underwent intestinal resection with re-anastomosis due to segmental inflammation with necrosis of terminal ileum [ 9 , 17 , 27 ].…”

“…When considering imaging studies, ileitis or colitis were present approximately in 4–28% of cases [ 6 , 7 , 13 , 23 , [27] , [28] , [29] , [30] , [31] ]. Moreover, a diagnosis of mesenteric adenitis in MIS-C has been accounted by 8 case-series, with a prevalence of 9–20% of the abdominal imaging studies [ 6 , 8 , 13 , 16 , 23 , 27 , 31 , 32 ]. In addition, the latter condition has been also described in six recent case-reports from different geographic areas [ 9 , 25 , 26 , 30 , 33 , 34 ]: notably, in one of those patients mesenteric lymphadenitis was even confirmed on surgical specimens by pathologists [ 9 ].…”

“…Several authors reported acute abdomen presentation in a not negligible number of patients. Our systematic review of literature evidenced acute abdomen presentation up to 30% [ 16 , 18 , [20] , [21] , [22] , [23] , [24] ]. It is attractive to speculate that vascular damage could probably play a role as well with this regard.…”

COVID-19-Associated Multisystem Inflammatory Syndrome Complicated with Giant Coronary Artery Aneurysm

“…A recent study by Whittaker et al reported two giant CAAs ( z -score >10) in children with multiple systemic inflammations during the COVID-19 pandemic. The involvement of coronary arteries in COVID-19-associated MIS-C patients, even in the absence of typical criteria for KD, indicates the need for more attention to these vessels, especially if the patient has symptoms of shock or severe systemic inflammation [ 20 ].…”

Clinical Characteristics of Paediatric Hyperinflammatory Syndrome in the Era of Corona Virus Disease 2019 (COVID-19)

“…A handful number of hospitalized cases in infants and children were reported compared to adults in hospitals in Navarra, Spain during the first wave of the COVID-19 outbreak (February–May 2020) [ 14 ]. Ten febrile children were hospitalised with COVID-19 infection demonstrating characteristics of PIMS in northern Iran from 28th March to 24th June 2020 [ 15 ]. First such case in India was reported from Chennai on the 10th May, 2020 [ 16 ].…”