COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

Abstract

Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of coronavirus disease 2019 (COVID-19) in children, which is increasingly being reported worldwide. Here we report the first case series of 7 children diagnosed with MIS-C in Qatar. Methods Clinical features and outcomes of COVID-19 positive patients admitted to Sidra Medicine, Qatar from June to October 2020, who met the WHO case definition for MIS-C were reviewed. Results The mean age in our case series was 5.6 years, of which 71.4% were males. All patients were previously healthy but had a history of COVID-19 infection. Fever, rash, vomiting and abdominal pain were the most common symptoms (70–100%). The average hospitalization was 12.9 days with no case fatalities. Laboratory findings included lymphopenia and thrombocytopenia in most patients, as well as evidence of coagulopathy and elevated inflammatory markers such as C-reactive protein, ferritin and procalcitonin. Many patients (71.4%) required inotropic support in intensive care, while only one required respiratory support. Although all patients had elevated cardiac biomarkers, cardiovascular involvement was observed in 42.9% of patients with one patient developing a giant coronary aneurysm. All patients received intravenous immunoglobulin (IVIG) and 86% of patients received corticosteroids, with two patients requiring treatment with IL-1 inhibitors. Conclusions Our report is one of the first reports on MIS-C from Asia. Although clinical features and outcomes are not significantly different from those reported elsewhere, lack of case fatalities in our cohort may indicate that early recognition and prompt medical attention is necessary for a favorable outcome in MIS-C.

Multisystem Inflammatory Syndrome and Autoimmune Diseases Following COVID-19: Molecular Mechanisms and Therapeutic Opportunities

“…MIS-C is an uncommon but serious medical condition which is associated with SARS-CoV-2 ( Hasan et al, 2021 ). The disease seems to develop from a dysregulated immune response, resulting in endothelial dysfunction and a hyperinflammatory state, which eventually causes capillary leak, followed by multiorgan failure ( Panaro and Cattalini, 2021 ).…”

“…The disease seems to develop from a dysregulated immune response, resulting in endothelial dysfunction and a hyperinflammatory state, which eventually causes capillary leak, followed by multiorgan failure ( Panaro and Cattalini, 2021 ). MIS-C is characterized by inflammation in multiple organs such as the brain, kidneys, heart, eyes, lungs, skin, or gastrointestinal system ( Hasan et al, 2021 ). Therefore, the clinical picture can be wide, depending on the severity and organ manifestation ( Panaro and Cattalini, 2021 ).…”

“…MIS-C shares some clinical features with Kawasaki disease (KD), which is a paediatric, self-limited, systemic inflammatory vasculitis, and macrophage activation syndrome (MAS); however, it is considered a different condition with a wide variety of clinical presentation ( Al Maskari et al, 2021 ; Appleberry et al, 2021 ; Haoudar et al, 2021 ; Hasan et al, 2021 ; Jain et al, 2021 ; Tolunay et al, 2021 ). It is reported that 40% of patients with MIS-C met the criteria for either incomplete or complete KD ( Feldstein et al, 2020 ).…”

“…Therefore, the American Academy of Pediatrics and the American Heart Association guideline suggested the use of high doses of immunoglobulins (2 g/kg) within 8–12 h with high doses of aspirin for the treatment of KD ( Newburger et al, 2004 ). Several studies reported the use of IVIG for the treatment of MIS-C either alone or in combination with other therapies ( Consiglio et al, 2020 ; Diorio et al, 2020 ; Garcia-Dominguez et al, 2020 ; Kaushik et al, 2020 ; Appleberry et al, 2021 ; Hasan et al, 2021 ; Jonat et al, 2021 ; Karthika et al, 2021 ; Shahein et al, 2021 ; Yasuhara et al, 2021 ). For example, in a study by Pouletty et al on 16 patients with MIS-C, 15 patients received IVIG, and only 5 (31%) showed remission after single IVIG treatment and others required second-line treatment ( Pouletty et al, 2020 ).…”

Clinical Characteristics, Laboratory Findings, Management, and Outcome of Severe Coronavirus Disease 2019 in Children at a Tertiary Care Center in Riyadh, Saudi Arabia: A Retrospective Study

“…The condition is mild for most children, according to these COVID-19 studies in children, with a vast number of children remaining asymptomatic. However, MIS-C represents a subpopulation of children who are more prone to acquiring major disorders related to COVID-19 ( 2 , 5 ). In a recent study of MIS-C in children and adolescents, 186 cases were discovered across the United States.…”