Gastrointestinal Symptoms as a Major Presentation Component of a Novel Multisystem Inflammatory Syndrome in Children That Is Related to Coronavirus Disease 2019: A Single Center Experience of 44 Cases

Abstract

U ntil recently, the clinical course of coronavirus disease 2019 (COVID-19) in children has been reported to be largely mild. 1,2 Recently, it has become evident that a subset of children exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can become critically ill with a condition now referred to as multisystem inflammatory syndrome in children (MIS-C), characterized by systemic hyperinflammation with fever and multisystem organ dysfunction. 3 Gastrointestinal symptoms are increasingly recognized to be associated with the presentation of MIS-C, potentially confusing the diagnosis of MIS-C with other common, less toxic gastrointestinal infections and even inflammatory bowel disease. In the first published correspondence describing MIS-C in 8 patients from the United Kingdom, 100% presented with gastrointestinal (GI) symptoms. 4 Similarly, 6 of 10 patients from an Italian cohort had GI issues. 5 This is in contrast to adults, who most commonly present with respiratory symptoms and report GI symptoms in <10%-15% of cases. 6,7 We examined whether similar presentations and prevalence extended to our comparatively larger US cohort of 44 patients (<21 years old) with MIS-C.

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

“…Gastrointestinal signs and symptoms appear predominantly as presenting features of MIS-C [12,15,17,26]. Mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) were the other prevalent findings that were similar to the report of Whittaker et al in the UK [13].…”

“…Although no fatalities [12,15,17] or relatively few reported cases of paediatric deaths attributed to MIS-C [5,13] was reported, in this study 11% of patients died.…”

“…According to the French surveillance study, MIS-C might occur in fewer than two per 10 000 children [10]. Although case series of MIS-C have now been reported from the United States [5,11,12] and Europe including the UK [2,13], Spain [14], Italy [6], France [10,[15][16][17] and Switzerland [18], only a few cases have been reported from Asia [19,20]. The aim of this study was to describe the clinical and laboratory characteristics of 45 patients who met criteria for MIS-C in Iran.…”

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

“…We identified a total of 34 case series 3 , 6 , 7 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 and case reports 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 published between May and July 2020 that mention dermatologic findings in 736 unique children with MIS-C. Cutaneous manifestations were present in 417 of 736 patients (57%). Fifteen (44%) of these articles state “rash” as the sole descriptor of skin findings.…”

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

“…All children present with persistent fever. Typically, a substantial proportion of children present with abdominal symptoms, with some having symptoms of such severity that they had US and CT imaging, and some undergoing surgical procedures ( 10 , 11 , 31 ). The PIMS-TS spectrum includes disease entities that need urgent recognition and treatment, such as a toxic shock like presentation with hypovolaemia and shock, as well as Kawasaki-like disease with involvement of the coronary arteries ( 4 – 6 ).…”