Multisystem inflammatory syndrome (MIS-C) in an adolescent Nigerian girl with COVID-19: A call for vigilance in Africa

Onyeaghala, C. A.; Alasia, Datonye; Eyaru, Orezioghene; Paul, Nsirimobu Ichendu; Maduka, Omosivie; Osemwegie, Nosakhare; Ugwueze, Nkem; Ordu, Collins; Igbosi, Ebitei; Irabor, Mary; Eyidia, Emeka

doi:10.1016/j.ijid.2021.02.017

Cited by 14 publications

(20 citation statements)

References 16 publications

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“…Consequently, increased plasma levels of the terminal complement complex (sC5b9) suggest that complement activation and thrombotic microangiopathy are prevalent in COVID-19 and MIS-C patients ( 21 ). Although many of the described patients beside IVIG required an additional treatment with glucocorticoids, antibiotics, biological agents, and even plasmapheresis and renal replacement therapy, in many complete recovery was reported ( 10 , 17 , 22 , 23 , 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

et al. 2021

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Introduction: While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C). Published definition and criteria of MIS-C include persistent fever, multisystem involvement, and elevated markers of inflammation, without obvious microbial inflammation or other plausible diagnosis. However, the aim of this case report is to emphasize the diversity of symptoms of MIS-C, beyond the defined criteria.Case Presentation: We present a 10-year-old boy with 8p23.1 microdeletion syndrome and multiple comorbidities who initially came to our attention due to hematuria, persistent fever, rash, and elevated markers of inflammation. Within the next 2 days, his condition worsened despite the broad-spectrum antibiotic therapy. Assuming his past history of SARS-CoV-2 exposure, MIS-C was suspected. A high level of clinical suspicion was further supported by significant clinical features (vomiting, abdominal pain, conjunctivitis, arrhythmia, and mild left ventricular systolic dysfunction with pleural effusion) along with laboratory findings (elevated ESR, CRP, proBNP, D-dimers and fibrinogen, positive IgG SARS-CoV-2 antibodies, and negative microbiological cultures). The patient was given intravenous immunoglobulin (IVIG) and began to show instantaneous clinical and laboratory improvement.Conclusion: Despite numerous reports of MIS-C cases in children, there are still many uncertainties regarding the clinical presentation and laboratory findings, as well as mechanisms beyond this intriguing disorder. In our case, for the first time hematuria is reported as an early symptom of MIS-C. We strongly believe that reporting various manifestations and outcomes in MIS-C patients will lead to improved diagnosis, treatment, and overall understanding of this novel inflammatory condition.

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Section: Discussionmentioning

confidence: 99%

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

et al. 2021

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“…Multi-system in ammatory syndrome in children (MIS-C) emerged in 2020 as a serious paediatric manifestation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been described throughout the world [1][2][3][4]. MIS-C is reported in less resourced settings [5][6][7][8] but there are very few reports from Africa [9][10][11]. The incidence of a child developing MIS-C after exposure to SARS-CoV-2 is not well known as exposure rates to SARS-CoV-2 in children are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Features and Estimated Incidence of MIS-C in Cape Town, South Africa

Butters

Abraham

Stander

et al. 2022

Preprint

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Background Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. Methods A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed. Results 68 children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). 97 healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p=0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. 94.1% received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. 39.7% required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR=1.523, CI 1.074, 2.16, p=0.018). The median hospital stay duration was 7 days with no deaths. Conclusion The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment.

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“…In April of 2020, MIS-C was first described in reports of children presenting with a severe multisystem hyperinflammatory illness temporally associated with preceding severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or exposure 1,2 . Since that time, cases have been reported on six continents, and as of June 28, 2021 the Centers for Disease Control and Prevention (CDC) has reported 4196 confirmed US MIS-C cases with 37 deaths 3,4,5,6,7,8 .…”

Section: Introductionmentioning

confidence: 99%

IVIG Compared With IVIG Plus Infliximab in Multisystem Inflammatory Syndrome in Children

Cole¹,

Osborne²,

Silveira

et al. 2021

Pediatrics

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This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

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Multisystem inflammatory syndrome (MIS-C) in an adolescent Nigerian girl with COVID-19: A call for vigilance in Africa

Cited by 14 publications

References 16 publications

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

The Clinical Features and Estimated Incidence of MIS-C in Cape Town, South Africa

IVIG Compared With IVIG Plus Infliximab in Multisystem Inflammatory Syndrome in Children

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