Pediatric Inflammatory Multisystem Syndrome (PIMS) – Potential role for cytokines such Is IL-6

Abstract

COVID-19 is a transmissible respiratory disease caused by coronavirus SARS-CoV-2, which is similar to SARS or MERS. Its increased severity was noted in aged patients usually over 65 years of age. Children and young people have an asymptomatic or mild course of the disease. Unfortunately, the number of children with problems after mild or asymptomatic COVID-19 recovery is increasing and their troubles resemble Kawasaki disease, although the laboratory findings seem to be different. This condition is called pediatric inflammatory multisystem syndrome (PIMS), and it is a new disease seen in children directly influenced by previous SARS-CoV-2 infection. The literature reports that PIMS typically follows 2–4 weeks after SARS-CoV-2 infection. The clinical symptoms of the affected children are extremely complex, ranging from gastrointestinal to cardiovascular problems with frequent skin and mucosal manifestations, and without intensive treatment they can be fatal. The exact causes of PIMS are recently unknown, however, it is explained as hyperactivation of immunity. In this minireview, we summarize data on the prominent role of the IL-6–IL-6R–STAT3 axis in PIMS aetiopathogenesis. Therapeutic manipulation of IL-6 or IL-6 receptor could be an approach to the treatment of children with severe PIMS.

Risk factors of a severe course of pediatric multi-system inflammatory syndrome temporally associated with COVID-19

“…From the clinical experience and literature, it is known that PIMS-TS is a group of clinical and laboratory symptoms that occur in children after usually mild or asymptomatic SARS-CoV-2 infection. PIMS-TS most often causes multi-organ damage and even leads to shock [ 5 ]. In the literature, the average age of children suffering from PIMS-TS is 8 years and male sex seems to be slightly more predisposing [ 1 ].…”

Changes in the cardiovascular system in children with pediatric multisystem inflammatory syndrome temporally associated with COVID-19 – A single center experience

“…Despite the fact that most children usually undergo SARS-CoV-2 infection mildly or asymptomatically, the post infectious complications in the form of a new disease entity called the PIMS-TS may be life threatening condition to pediatric patients ( 7 ). PIMS-TS initially appeared to be a similar disease to the well-known Kawasaki disease (KD) due to the fact that some patients present symptoms such as fever, rash, enlargement of peripheral lymph nodes, dermal and mucosal changes, and severe changes in the cardiovascular system that may lead to serious complications ( 8 ).…”

“…These patients presented splenomegaly, persistent fever, exceptionally high levels of ferritin, pancytopenia, coagulopathy, hypertriglyceridemia and liver dysfunction. The etiology of this syndrome is not yet fully understood, but it seems that genetically susceptible patients develop PIMS-TS as a result of a cytokine storm approximately 4–6 weeks after the infection ( 7 , 10 ). The most frequently mentioned inflammatory cytokines in the etiopathogenesis of PIMS-TS are i.e., interleukin 1, 6, and tumor necrosis factor (TNF) ( 11 , 12 ).…”

Paediatric Inflammatory Multisystem Syndrome: A Diagnostic Challenge in a COVID-19-Negative Patient

“…The presentation can be similar to cytokine storm which is a serious and fatal complication of SARS-CoV-2 infection in adults. As in cytokine storm, IL-6 plays a key role in PIMS: it interacts with the cytokine and STAT3, and produces a complex panel of cytokines which are responsible for PIMS activation [ 6 ] . The European Centre for Disease Prevention and Control (ECDC) released a publication on 15 May 2020 stating that there had been five deaths among 250 cases of PIMS [ 7 ] .…”