Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS‐C) and COVID‐19 Treated With Infliximab

Abstract

What is known?  Coronavirus disease 2019 (COVID-19) may lead to severe inflammatory response and cytokine storm.  More than 200 patients with multisystem inflammatory syndrome in children and adolescents (MIS-C) temporally related to COVID-19 infection have been reported.  Anti-Tumor necrosis factor-α therapy with infliximab is effective for the induction and maintenance of remission in pediatric Crohn's disease patients. What is new?  Higher levels of pro-inflammatory cytokines can be seen in patients with inflammatory bowel disease and cytokine storm associated with COVID-19 infection than are reported in either inflammatory bowel disease or with COVID-19 alone.  Infliximab therapy can effectively treat both pediatric Crohn's disease and MIS-C temporally associated with COVID-19 infection.

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.…”

“…Some smaller case series and case reports provide more detailed characterizations: polymorphic, maculopapular, morbilliform, and diffuse erythroderma were the most common morphologies noted. 3 , 25 , 34 , 38 , 39 , 40 , 45 , 46 , 48 , 51 Skin lesions in single case reports were described as urticarial 34 , reticular 47 , petechial 32 , and purpuric. 46 …”

Rapid Antibody-Based COVID-19 Mass Surveillance: Relevance, Challenges, and Prospects in a Pandemic and Post-Pandemic World

“…Contextually, as one of the later developments in the COVID-19-related complications, MIS-C or multisystem inflammatory syndrome in children needs a special mention [ 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 ]. On 2 May 2020, a Pediatric Intensive Care-COVID-19 international collaborative conference call was held, where panelists recognized MIS-C as an emerging effect of COVID-19 infections in children [ 177 ].…”

Management of immunotherapy colitis: Special considerations in the COVID‐19 era

“…The approach to the evaluation of patients with suspected ICI-induced colitis and their management is based on symptom severity. For patients with grade 3 symptoms (≥7 bowel movements per day by common terminology criteria for adverse events [CTCAE]), guidelines predating the coronavirus disease 2019 (COVID- 19) pandemic traditionally have recommended immunosuppression with high-dose glucocorticoids (1-2 mg/kg). 6,7 Adjunctive biologic agents, including a tumor necrosis factor (TNF) α inhibitor (eg, infliximab) and anti-integrin antibody (eg, vedolizumab), typically are reserved for patients with steroid-refractory colitis.…”

“…A role for the blockade of TNF-α in the treatment of the COVID-19 inflammatory cascade has been suggested in a case report, but additional data are needed. 19 The role of systemic glucocorticoids in the treatment of COVID-19 is rapidly evolving. Systemic glucocorticoids are used in patients with early acute respiratory distress syndrome and/or marked inflammatory responses to COVID-19.…”