American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS‐C) Associated with SARS‐CoV‐2 and Hyperinflammation in COVID‐19. Version 2.

AbstractIntroductionMultisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions.Case presentationAn eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

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Clinical characteristics and outcome of hospitalized children and adolescent patients with type 1 diabetes during the COVID-19 pandemic: data from a single center surveillance study in Egypt

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0099 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Eman Monir Sherif ◽

Yasmine Ibrahim Elhenawy ◽

Randa Mahmoud Matter ◽

Hanan Hassan Aly ◽

Rasha Adel Thabet ◽

...

Keyword(s):

Type 1 Diabetes ◽

Pediatric Patients ◽

Surveillance Study ◽

Single Center ◽

Children And Adolescent ◽

Mean Delay ◽

Patients With Diabetes ◽

Constant Feature ◽

Inflammatory Syndrome

Abstract Objectives COVID-19 pandemic significantly impacted the diagnosis of type 1 diabetes and its acute complications. Thus, the study aimed to evaluate the characteristics of pediatric patients with type 1 diabetes hospitalized during the first wave of the pandemic and the prevalence of new onset diabetes among patients with evidence of COVID-19 infection. Methods A single-center surveillance study included all patients with diabetes admitted to Children’s Hospital, Ain Shams University, in Egypt between May to August 2020. Data were collected to evaluate patients’ clinical and laboratory characteristics as well as their outcomes. Results Thirty-six patients were admitted during the study period. The mean age was 8.4 ± 3.8 years. Patients presented late to the emergency department with a mean delay of 3.05 ± 1.19 days from onset of symptoms. 34/36 patients presented in diabetic ketoacidosis (DKA), 50% presenting in severe DKA. Almost 81% of the patients were newly diagnosed. During the study period, SARS-CoV-2 PCR was found positive in four patients, COVID Ig M antibodies were positive in another two patients; all were symptomatic requiring ICU admission. Four patients showed a picture suggestive of the multi-inflammatory syndrome (MIS-C); cardiac affection was a constant feature. Conclusions The pandemic affected both the prevalence and severity of DKA among pediatric patients. The increased prevalence of severe DKA could be partly related to delayed hospital admission or the effect of COVID-19 in triggering DKA. Efforts should be done to continuously raise awareness about diabetes in children as well as the importance of seeking timely medical guidance.

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Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Kidney International ◽

10.1016/j.kint.2021.02.026 ◽

2021 ◽

Author(s):

Abby Basalely ◽

Shari Gurusinghe ◽

James Schneider ◽

Sareen S. Shah ◽

Linda B. Siegel ◽

...

Keyword(s):

Acute Kidney Injury ◽

Pediatric Patients ◽

Kidney Injury ◽

Inflammatory Syndrome

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SARS-CoV-2 antibody responses in children with MIS-C and mild and severe COVID-19

10.1101/2020.08.17.20176552 ◽

2020 ◽

Cited By ~ 5

Author(s):

Elizabeth M. Anderson ◽

Caroline Diorio ◽

Eileen C. Goodwin ◽

Kevin O. McNerney ◽

Madison E. Weirick ◽

...

Keyword(s):

Pediatric Patients ◽

Antibody Responses ◽

Inflammatory Syndrome

SARS-CoV-2 antibody responses in children remain poorly characterized. Here, we show that pediatric patients with multisystem inflammatory syndrome in children (MIS-C) possess higher SARS-CoV-2 spike IgG titers compared to those with severe coronavirus disease 2019 (COVID-19), likely reflecting a longer time since onset of infection in MIS-C patients.

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Cardiac Findings in Pediatric Patients With Multisystem Inflammatory Syndrome in Children Associated With COVID-19

Clinical Pediatrics ◽

10.1177/0009922820961771 ◽

2020 ◽

pp. 000992282096177 ◽

Cited By ~ 2

Author(s):

Prashant K. Minocha ◽

Colin K. L. Phoon ◽

Sourabh Verma ◽

Rakesh K. Singh

Keyword(s):

New York ◽

Pediatric Patients ◽

High Rate ◽

Screening Tests ◽

Cardiac Complications ◽

Study Cohort ◽

Large Hospital ◽

Inflammatory Syndrome ◽

Cardiac Testing

Background The overall severity of cardiac disease secondary to acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection in children appears to be much lower when compared with adults. However, the newly described multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been associated with cardiac complications. Methods We reviewed the clinical course and cardiac testing results in pediatric patients hospitalized with MIS-C at 2 large hospital systems in the New York City metropolitan area over a 3-month period. Results Of the 33 patients (median age 2.8 years) in the study cohort, 24 (73%) had at least one abnormality in cardiac testing: abnormal electrocardiogram (48%), elevated brain natriuretic peptide (43%), abnormal echocardiogram (30%), and/or elevated troponin (21%). Electrocardiogram and echocardiogram abnormalities all resolved by the 2-week outpatient follow-up cardiology visit. Conclusion While 73% of pediatric patients with MIS-C had evidence of abnormal cardiac testing on hospital admission in our study, all cardiac testing was normal by outpatient hospital discharge follow-up. Cardiac screening tests should be performed in all patients diagnosed with MIS-C given the high rate of abnormal cardiac findings in our study cohort.

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Oral manifestations of COVID-19 related multi-system inflammatory syndrome in children: a review of 47 pediatric patients

The Journal of the American Dental Association ◽

10.1016/j.adaj.2020.11.014 ◽

2020 ◽

Author(s):

Steven Halepas ◽

Kevin C. Lee ◽

Aaron Myers ◽

Richard K. Yoon ◽

Wendy Chung ◽

...

Keyword(s):

Pediatric Patients ◽

Oral Manifestations ◽

Inflammatory Syndrome

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Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

Clinics ◽

10.6061/clinics/2020/e2209 ◽

2020 ◽

Vol 75 ◽

Author(s):

Maria Fernanda Badue Pereira ◽

Nadia Litvinov ◽

Sylvia Costa Lima Farhat ◽

Adriana Pasmanik Eisencraft ◽

Maria Augusta Bento Cicaroni Gibelli ◽

...

Keyword(s):

High Mortality ◽

Pediatric Patients ◽

Clinical Spectrum ◽

Inflammatory Syndrome

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A Systematic Review of Severe Neurological Manifestations in Pediatric Patients with Coexisting SARS-CoV-2 Infection

Neurology International ◽

10.3390/neurolint13030041 ◽

2021 ◽

Vol 13 (3) ◽

pp. 410-427

Author(s):

Lauren O’Loughlin ◽

Nilo Alvarez Toledo ◽

Leon Budrie ◽

Randall Waechter ◽

Joanna Rayner

Keyword(s):

Systematic Review ◽

Immune Response ◽

Neurological Disorders ◽

Respiratory Symptoms ◽

Literature Search ◽

Pediatric Patients ◽

Neurological Manifestations ◽

Critical Factors ◽

Age Range ◽

Inflammatory Syndrome

SARS-CoV-2 infection in children produces mild respiratory symptoms or no symptoms at all in most cases. Some pediatric patients develop a severe complication associated with high mortality, the multisystem inflammatory syndrome in children (MIS-C). In both scenarios, there are reports of neurological manifestations. This article aims to review the cases of pediatric patients with severe neurological issues and a coexisting positive SARS-CoV-2 test. A literature search was performed between March 2020 and May 2021. The results included the data from 41 studies, with 159 children with severe neurological manifestations, within an age range from 24 h to 17 years. The neurological disorders included 38 cases with stroke, 32 with encephalitis, 22 with encephalopathy, and 10 with Guillain–Barre syndrome. Sixty-five out of 159 cases with severe neurological manifestations were diagnosed with MIS-C. Direct neuroinvasion and the exaggerated immune response in some patients seem to be the most critical factors triggering these manifestations. Further research in the ongoing pandemic is needed to elucidate the precise mechanism.

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A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

PRILOZI ◽

10.2478/prilozi-2021-0027 ◽

2021 ◽

Vol 42 (2) ◽

pp. 95-101

Author(s):

Lidija Kareva ◽

Katarina Stavrik ◽

Kristina Mironska ◽

Arjeta Hasani ◽

Sonja Bojadzieva ◽

...

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Close Contact ◽

Multiorgan Failure ◽

Gastrointestinal Symptoms ◽

Gastrointestinal Diseases ◽

Serological Testing ◽

Inflammatory Syndrome ◽

Pcr Test

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

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