Clinical Characteristics of Pediatric Inflammatory Multisystem Syndrome Associated With COVID-19

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 was defined as pediatric inflammatory multisystem syndrome (PIMS). The purpose of this report is to describe 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 a tertiary hospital in the north of Iran. Demographic and clinical characteristics, laboratory and imaging findings and therapeutic modalities were recorded and analysed. Results: The mean age of patients was 5.37±3.9 years (13 months to 12 years). Six of them were boy. 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 impression. All of them had increased C-reactive protein level and most of them had an elevated erythrocyte sedimentation rate, lymphopenia, anemia, and hypoalbuminemia. Some of them had thrombocytopenia. 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 discharged with a giant coronary aneurysm.Conclusion: Children with COVID-19 may present symptoms similar to Kawasaki disease and inflammatory syndromes. PIMS should be considered in children with fever and rash, seizure, cough, tachypnea, and gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain.

Clinical Characteristics and Outcomes of COVID-19 in Children in Northern Iran

“…There are reports of dermatologic manifestation in COVID-19, and fever and rash were the first presentation of COVID-19 [ 12 , 23 , 24 ]. In some cases, the rash was associated with PIMS [ 25 , 26 ].…”