Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

Krawiec, Paulina; Opoka-Winiarska, Violetta; Pac-Kożuchowska, Elżbieta

doi:10.3390/jcm11102765

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Interestingly, there have been reported MIS-C cases where abdominal imaging reveals inflammation of the bowel wall in the distal ileum and mesenteric fat, a usual finding in IBD cases [ 33 ]. The overlapping symptoms of PIBD exacerbation and MIS-C pose a challenge for accurate diagnosis and decision on the appropriate treatment [ 23 , 33 , 34 , 35 ]. Physicians should be aware of the clinical presentations of both entities in order to provide the best available care to their patients.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

Batsiou

Mantzios

Piovani

et al. 2022

JCM

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The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with PIBD. A systematic search of PubMed and Scopus databases was conducted to identify studies published up until September 2022. Out of the 475 articles screened, 14 studies were included in the review. Of the 4006 children with PIBD included, 390 (9.7%) tested positive for COVID-19. Among those with COVID-19, 5.9% (0–16.7%) needed hospitalization, 0.6% (0–1%) were admitted to the pediatric intensive care unit (PICU), and no deaths were reported. Among the included studies, only four presented details regarding patients’ symptoms, with 21% (0–25%) presenting gastrointestinal (GI) symptoms. An association between PIBD activity or specific treatment and COVID-19 outcome could not be established. The prevalence of COVID-19 in patients with PIBD was low; therefore, the initial concerns regarding higher infection risk and worse prognosis in this population are not supported by the currently available data. Further research is needed to determine the natural history of the infection and the optimal treatment for these patients. Much is still unclear and additional studies should be performed in order to optimize prevention and care for this special group of patients.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

Batsiou

Mantzios

Piovani

et al. 2022

JCM

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“…In the 8 cases of KD with appendicitis published so far, histological findings showed found focal inflammation with neutrophilic and eosinophilic infiltration in one patient and transmural inflammation and arteritis in another one ( 33 ). In case of persistent postoperative fever, especially if other systemic signs appear, the diagnosis should be reconsidered, with the awareness that KD tends to affect younger patients than MIS-C ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Histological findings of peri-appendicitis in three children with SARS-CoV-2 – related multisystem inflammatory syndrome: A mark for systemic inflammation?

et al. 2022

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BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition that can potentially develop after SARS-CoV-2 infection in children. Gastrointestinal manifestation in MIS-C can mimic acute abdomen, potentially leading to unnecessary surgical treatment. Immune-mediated mechanisms seem to be a determining factor in its pathogenesis, and histological studies can help to shed light on this aspect. We describe three cases of children diagnosed with MIS-C that underwent appendectomy.MethodsWe retrospectively collected the clinical features and histological findings of three previously healthy children who underwent appendectomy for clinical suspicion of acute appendicitis but were later diagnosed with MIS-C.FindingsThe three children presented with prominent abdominal manifestations and fever leading to the suspicion of acute abdomen. Histological findings showed transmural and perivascular inflammation. Notably, CD68+ macrophages were predominant in the child with milder abdominal symptoms without cardiac injury, while CD3+ lymphocytes in the patient presented with more severe abdominal pain and cardiovascular involvement at admission.InterpretationGastrointestinal symptoms of children with MIS-C improve after proper immunomodulatory therapy, conversely showing inadequate response to surgical appendectomy. Histological findings revealed different inflammatory cell infiltration that primarily involved perivisceral fat and vessels, and subsequently mucosal tissue, in contrast to other forms of acute appendicitis. Our findings suggest that this kind of peri-appendicitis in MIS-C could represent a focal sign of systemic inflammation, with different histological patterns compared to other forms of acute appendicitis.

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“…Podstępne i ciężkie objawy żołądkowo-jelitowe PIMS mogą naśladować nagłe przypadki chirurgiczne w obrębie jamy brzusznej, w tym ostre zapalenie wyrostka robaczkowego, infekcje żołądkowo-jelitowe lub nieswoiste zapalenie jelit. [5] Typowo u chorych obserwujemy ból brzucha, biegunkę oraz wymioty. W badaniach laboratoryjnych notujemy podwyższone enzymy wątrobowe (33,3%) [6].…”

Section: Wstępunclassified

PIMS - symptoms and short/long-term gastrointestinal and cardiovascular system complications

GRUDZIŃSKA¹,

DUDZIŃSKA²,

MILANOWSKA³

et al. 2023

J Educ Health Sport

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PIMS (paediatric inflammatory multisystem syndrome associated with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C)) is a new disease classification, occurring in children and young adults associated with the SARS-CoV-2 infection. Although children suffer from COVID-19 infection asymptomatically or mildly, long-term complications of the disease may be more severe for them than for adults. Despite the fact that PIMS is a relatively new disease, we already know that it should not be underestimated. In spite of the clinical picture of these complications may resemble Kawasaki Disease (KD), we may notice some differences in laboratory tests (such as reduced number of lymphocytes, decreased platelet count or elevated ferritin levels). Although usually the first symptom of PIMS is high fever, it is followed by symptoms related to the digestive system, present in about 80% of cases. The insidious and severe gastrointestinal symptoms of PIMS can mimic abdominal surgical emergencies, including acute appendicitis, gastrointestinal infections or inflammatory bowel disease. Cardiovascular symptoms occur in approximately 60% of patients with PIMS. Immunomodulatory therapy plays an essential role in the treatment of PIMS. The exact causes of PIMS are recently unknown, however, it is explained as genetic hyperactivation of immunity. In this minireview we summarize the most recent data about this condition, mainly we are focusing on gastrointestinal and cardiovascular symptoms, short/long-term complications and treatment.

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Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

Cited by 9 publications

References 24 publications

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

Case report: Histological findings of peri-appendicitis in three children with SARS-CoV-2 – related multisystem inflammatory syndrome: A mark for systemic inflammation?

PIMS - symptoms and short/long-term gastrointestinal and cardiovascular system complications

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