Post-COVID-19 Multisystem Inflammatory Syndrome in Children and Adults: What Happens After Discharge?

Abstract

Introduction Classification criteria and practice guidelines for inpatient management of multisystem inflammatory syndrome (MIS) exist, but reports on outpatient management and clinical outcomes are lacking. Here we describe the management and clinical outcomes of four children and four adults with MIS seen at Walter Reed National Military Medical Center (WRNMMC) from diagnosis to six months follow-up. Methods This retrospective, case-series describes the initial presentation and management of MIS in four children and four adults seen at WRNMMC from March 2020 to September 2021. Data on each patient was collected from the time of exposure to the SARS-CoV-2 virus to six months post-diagnosis with MIS. Extracted data includes: demographics, comorbidities, initial MIS presentation, inpatient treatment, outpatient treatment, and clinical outcomes. Results A total of 62.5% of patients presented in shock. All pediatric patients received IVIG, methylprednisolone, and anakinra; no adult received this combination. Steroids and immunomodulatory medications were discontinued in 1-2 months outpatient. Three children and two adults had full symptomatic resolution. One child and two adults had persistent deconditioning at six months follow-up. One adult had persistent dyspnea. Conclusions MIS appears to be monophasic with no recurrences at six months follow-up in our patients who only required 1-2 months of glucocorticoid or immunomodulatory medications. The better outcomes in children raise the question of how much of this difference can be attributed to early combination therapy versus physiologic differences in children and adults.

A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

“…Coronary abnormalities were also improved in most of the cases within 3 months [37]. Almost a complete recovery was reported 6 months after the discharge among MIS-C patients [115 ▪ ]. More than 50 patients are being followed in our center for more than 2 years, but no significant sequel has been noted, thus far.…”

Serum Pentraxin 3 as Promising Biomarker for the Long-Lasting Inflammatory Response of COVID-19

“…Several studies demonstrated that a prolonged pro-inflammatory state, which is characterized by the increase in inflammatory markers, such as IL-1β, IL-6, and TNF-α, is a distinctive feature of patients with long COVID-19 [ 12 ] since these inflammatory alterations have been shown to persist in some patients for several months after infection, leading to a condition clinically known as post-COVID-19 multisystem inflammatory syndrome (MIS) or a systemic inflammatory response (SIR) [ 13 , 14 ].…”