Multisystem Inflammatory Syndrome in Children

Waseem, Muhammad; Shariff, Masood A.; Tay, Ee Tein; Mortel, David; Savadkar, Shivraj; Lee, Horton; Kondamudi, Noah P.; Liang, Tian

doi:10.1016/j.jemermed.2021.07.070

Cited by 30 publications

(37 citation statements)

References 48 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our understanding of the pathogenesis of this syndrome is evolving but remains limited. Whereas genetic predisposition to developing severe MIS-C has been demonstrated (19), the true triggers for the severe inflammatory response seen in otherwise healthy individuals with MIS-C and characterized by increased plasma cytokine levels including IL-6, IL-8, IFNγ, IL-17, TNFα, and IL-10 and the multilineage immune cell activation remain unknown (20)(21)(22)(23)(24). A specific immunopathologic signature and association with HLA alleles were identified recently that may pave the way for the development of more specific biomarkers (25).…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

et al. 2023

View full text Add to dashboard Cite

IntroductionReports of multisystem inflammatory syndrome in children (MIS-C), following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, have been increasing worldwide, with an incidence varying significantly across studies based on the definition used for the diagnosis. At our tertiary medical center in Lebanon, we encountered several cases that presented a diagnostic challenge because they mimicked MIS-C but did not meet the US Centers for Disease Control and Prevention (CDC) definition. We decided to review these cases and describe their features in comparison with cases that met the CDC criteria of MIS-C and those that had an alternative diagnosis.MethodsThis is a retrospective chart review of subjects aged <19 years old admitted to the American University of Beirut Medical Center (AUBMC) between March 1, 2020, and May 31, 2021, with suspected or confirmed MIS-C, following documented COVID-19 infection, with sufficient or insufficient criteria for diagnosis. Subjects were classified into 3 groups: “MIS-C”, “Near MIS-C” and “Alternative Diagnosis”.ResultsA total number of 29 subjects were included in our cohort. Fever was present in all subjects. In the MIS-C group, evidence for cardiovascular system involvement was the most common feature followed by the mucocutaneous and gastrointestinal systems. In the “Near MIS-C” and “Alternative Diagnosis” group, gastrointestinal symptoms were the most common with only one patient with cardiac abnormalities and none with coagulopathy. Subjects with typical MIS-C presentation had higher inflammatory markers when compared to subjects in the other groups. Almost all the subjects had positive IgG for SARS-CoV-2. Of the 29 subjects, the Royal College of Paediatrics and Child Health (RCPCH) case definition would have identified all suspected cases without an alternative diagnosis as MIS-C, whereas the World Health Organization (WHO) and the CDC definitions would have excluded 6 and 10 subjects, respectively.ConclusionMIS-C presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria. Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions.

show abstract

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The underlying mechanism of KD with myositis has not been elucidated since this complication is rare, and little literature focuses on this subject. KD is a multisystem inflammation that affects multiple organs with elevated inflammatory parameters, including ESR, CRP, and procalcitonin ( 2 , 27 ). Exaggeration of the immune response plays important role in the pathogenesis of multisystem inflammation.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Lower Limb Muscle Weakness in a Child With Kawasaki Disease

Huang

Peng²,

Li³

et al. 2022

Front. Pediatr.

View full text Add to dashboard Cite

Kawasaki disease (KD) is a systemic vasculitis that may impact multiple organ systems in children. Myositis is an unusual presentation of KD that presents with muscle weakness. To date, a few pediatric patients with KD and myositis have been reported. Diffuse muscle weakness involving the 4 limbs was the most common presentation in these children. However, isolated lower limb involvement was rarely reported before. Here, we report lower limb muscle weakness in an 18-month-old child with KD. He presented with fever, rash, conjunctival injection, peeling over fingers and toes, and progressive muscle weakness of the lower limbs. Muscle enzymes were normal, but electromyography indicated myositis. The symptom of fever was relieved quickly by intravenous immunoglobulin and aspirin, which were ineffective for myositis. However, lower limb muscle weakness fully recovered 5 days after prednisolone treatment. This rare case might add value to the growing literature exploring the association of KD with myositis.

show abstract

“…Cardiac involvement in MIS-C is common and is one of the most important factors affecting prognosis [ 19 , 20 , 21 ]. Myocarditis, LV dysfunction, pericarditis, valvulitis, and coronary artery dilatation are the main cardiac complications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Baseline Characteristics and Prognostic Factors in Multisystemic Inflammatory Syndrome in Children: Is It Possible to Foresee the Prognosis in the First Step?

Çetin

Kısaarslan

Tekin

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Two years after the first cases, critical gaps remain in identifying prognostic factors in multisystem inflammatory syndrome in children (MIS-C). Methods: This retrospective study included 99 patients with MIS-C hospitalized between August 2020 and March 2022 in a pediatric tertiary center. The patients were divided into two groups according to clinical severity (low- and high-risk). Prognostic values of baseline clinical and laboratory characteristics were evaluated with advanced statistical analysis, including machine learning. Results: Sixty-three patients were male, and the median age was 83 (3–205) months. Fifty-nine patients (59.6%) were low-risk cases. Patients aged six years and over tended to be at higher risk. Involvement of aortic or tricuspid valve or >1 valve was more frequent in the high-risk group. Mortality in previously healthy children was 3.2%. Intensive care unit admission and mortality rate in the high-risk group were 37.5% and 7.5%, respectively. At admission, high-risk patients were more likely to have reduced lymphocyte count and total protein level and increased brain natriuretic peptide (BNP), ferritin, D-dimer, and troponin concentrations. The multiple logistic regression model showed that BNP, total protein, and troponin were associated with higher risk. When the laboratory parameters were used together, BNP, total protein, ferritin, and D-dimer provided the highest contribution to the discrimination of the risk groups (100%, 89.6%, 85.6%, and 55.8%, respectively). Conclusions: Our study widely evaluates and points to some clinical and laboratory parameters that, at admission, may indicate a more severe course. Modeling studies with larger sample groups are strongly needed.

show abstract

Multisystem Inflammatory Syndrome in Children

Cited by 30 publications

References 48 publications

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

Case Report: Lower Limb Muscle Weakness in a Child With Kawasaki Disease

Evaluation of Baseline Characteristics and Prognostic Factors in Multisystemic Inflammatory Syndrome in Children: Is It Possible to Foresee the Prognosis in the First Step?

Contact Info

Product

Resources

About