Multisystem Inflammatory Syndrome in Children, the Real Disease of COVID-19 in Pediatrics - A Multicenter Case Series From Al-Ahsa, Saudi Arabia

Abstract

Fortunately, coronavirus disease 2019 (COVID-19) infection in pediatric populations exhibits a mild course of disease. However, a small number have recently been identified who develop a significant systemic inflammatory response, a new disease entity called multisystem inflammatory syndrome in children (MIS-C), especially after the peak of the wave in Al-Ahsa, Saudi Arabia, in early June to mid-July. In MIS-C children usually present a few days to a few weeks after recovery from COVID-19 with high grade fever, GI symptoms, Kawasaki-like picture or even toxic shock-like syndrome. Raising awareness about this disease entity is very fundamental to enable pediatricians and other health care providers to identify and manage these patients before it is too late. We describe 10 different cases of MIS-C with different risk factors and presentations.

Kawasaki Disease Shock Syndrome in the Eastern Region of Saudi Arabia: Case Series

“…Compared with multisystemic inflammatory shock in children with COVID 19 infection, the patients were significantly more hemodynamically unstable and had a higher incidence rate. Cardiovascular collapse was the cardinal sign in both KDSS and MIS-C. Globally, myocardial and valvular dysfunction are observed, but compared to what was observed here and in Almoosa et al peripheral vascular dysfunction is the main feature with minimal myocardial impairment [1,6,7].…”

“…One of them suggested that an unidentified infection could trigger the immune response that causes KD in genetically suspected individuals [ 1 , 2 ]. This was observed here in the study, and especially in the era of COVID 19 infection, where accurate co-recording and documentation of a previous or current COVID-19 infection increases the association between infections and the triggering of Kawasaki disease or multisystemic inflammatory shock in children with COVID-19 infection (MIS-C) [ 1 , 6 , 7 ].…”

SARS-CoV-2–related MIS-C: A key to the viral and genetic causes of Kawasaki disease?

“…There has been a striking paucity of MIS-C cases from East Asia, despite the high incidence of KD in this geographic area ( Kim et al, 2020b ; Li et al, 2019 ). Only two cases of MIS-C have been reported to date in South Korea, and no cases have been reported in Japan or China ( Toyo Keizai Online COVID-19 Task Team, 2021 ), contrasting with the higher numbers of cases from the Americas, Europe, Africa, South Asia, and the Middle East ( Almoosa et al, 2020 ; Dufort et al, 2020 ; Falah et al, 2020 ; Feldstein et al, 2020 ; Jain et al, 2020 ; Kim et al, 2020a ; Kim et al, 2020b ; Lee et al, 2021 ; Mamishi et al, 2020 ; Ulloa-Gutierrez et al, 2020 ; Verdoni et al, 2020 ; Webb et al, 2020 ). Whether this is merely due to a lower number of COVID-19 cases in East Asia remains to be seen, bearing in mind the possibility of ascertainment bias ( Fig.…”

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

“…[4] The true incidence of MIS-C is still uncertain but an estimated incidence of 0.6% among laboratory con rmed COVID-19 patients has been reported in New York. [5] To date, the majority of MIS-C cases have been reported from North America and European countries with very few reports from Asian countries [4][5][6][7][8][9]. Large case series conducted in the USA and UK show that risks associated with developing MIS-C may vary by gender, age and ethnicity.…”