Multisystem Inflammatory Syndrome due to COVID-19 in a Newborn Patient: A Case Report from Lebanon

Background: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with COVID-19 in children, with features that are similar to Kawasaki disease and toxic shock syndrome. Several reports are emerging from all over the world on this condition that is associated with increased fatality rate. Case Report: In this article, we present one of the first reports of a newborn diagnosed with MIS-C attributed to COVID-19. In addition, we discuss the diagnostic criteria and the possible pathophysiology. Conclusion: Although COVID-19 does not frequently affect newborns, when it does, it may lead to devastating complications, such as MIS-C. As a result, providers should be on the lookout for any symptoms that can indicate a complicated infection. Further studies are still needed to develop a better understanding of the pathophysiology of this disease and establish appropriate therapeutic guidelines.

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Severe Paediatric Multisystem Inflammatory Syndrome (PIMS) in a 23 months old baby post COVID-19 effectively managed with IVIG and pulse Steroid: Case report

10.21203/rs.3.rs-68719/v1 ◽

2020 ◽

Author(s):

Yogesh Kumar Gupta ◽

Sowmya Shenoy ◽

Kuldip G Paike ◽

Mrigendra Nath Tudu

Keyword(s):

Case Report ◽

Kawasaki Disease ◽

Toxic Shock Syndrome ◽

Supportive Treatment ◽

Immunomodulatory Drugs ◽

Toxic Shock ◽

Mild Disease ◽

Significant Difference ◽

Inflammatory Syndrome ◽

Pulse Steroid

Abstract Coronavirus disease (COVID-19) in children largely causes mild disease. Some of these recovered children may present with delayed manifestations described as Hyperinflammatory syndrome resembling closely with Kawasaki disease (KD) or Toxic Shock Syndrome (TSS). Timely identification, supportive treatment and treatment with immunomodulatory drugs make a significant difference in the outcome.

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Superantigenic TCR Vbeta 21.3 signature in Multisystem Inflammatory Syndrome in Children

10.1101/2021.02.11.21251166 ◽

2021 ◽

Author(s):

Marion Moreews ◽

Kenz Le Gouge ◽

Alicia Bellomo ◽

Christophe Malcus ◽

Rémi Pescarmona ◽

...

Keyword(s):

Immune Response ◽

T Cells ◽

T Cell ◽

Kawasaki Disease ◽

T Cell Activation ◽

Toxic Shock Syndrome ◽

Healthy Children ◽

Toxic Shock ◽

Hla Dr ◽

Inflammatory Syndrome

AbstractObjectivesMultiple Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric form of COVID-19 and occurs in previously healthy children. MIS-C combines features of Kawasaki disease and Toxic Shock Syndrome (TSS).MethodsChildren with suspected MIS-C were included within the first week of diagnosis and a large scale immunoassay was performed to determein the immunologic signature of these patients.ResultsWe characterized the immunological profile of 27 MIS-C cases in comparison with 4 KD and 4 TSS cases. Similarly to TSS, an increase of serum inflammatory cytokines (IL-6, TNF-a, CD25s) was observed in MIS-C contrasting with low expression of HLA-DR monocytes, a feature often associated with immune paralysis. Expansions of T cells expressing the Vβ21.3 T cell receptor β chain variable region were detected in both CD4 and CD8 subsets in almost 50% of patients and Vβ21.3-positive T cells expressed high level of HLA-DR highlighting their specific activation. TCR sequencing uncovered the polyclonal nature of the Vβ 21.3+ population. SARS-CoV2 antigene-specific production of interferon gamma in T cells was not increased in MIS-C T cells compared to COVID-19 patients suggesting the antigen-specific immune response in MIS-C patients is not pivotal to the manifestation.ConclusionsOur findings argue in favor of a strong activation of the immune system related to a superantigenic immune response in MIS-C with a specific polyclonal Vβ21.3 T cell expansion.Key messagesWhat is already known about this subject ?MIS-C occurs 3-5 weeks after acute SARS-CoV2 infection and overlap features of Toxic Shock syndrome and Kawasaki disease.MIS-C appears different in term of cytokine and autoantibodies generation from KD with subtle signs of T cells activationWhat does this study add?This study demonstrates that Vβ21.3+ CD4 and CD8 T cells are highly increased in about 50% of MIS-C and distinctive of the Vβ2+ expansion observed in toxic shock syndrome in This reflects a specific T cell activation and cytokine release syndrome similar to toxic shock syndromeHow mich this impact on clinical practice or future developments?Vβ21.3+ signature can be available on a short term basis by flowcytometry and represents a signature of the MIS-C.As for TSS, immunomodulating therapies may revert the superantigenic activation and resolve this life threatening pediatric condition.

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SARS-CoV-2-related Multisystem Inflammatory Syndrome in Children

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2021.21.02.021 ◽

2021 ◽

Vol 21 (2) ◽

pp. e302-307

Author(s):

Nawal Al Maskari ◽

Kholoud Al Mukhaini ◽

Safiya Al Abrawi ◽

Mohammed Al Reesi ◽

Juhaina Al Abulsalam ◽

...

Keyword(s):

Kawasaki Disease ◽

Toxic Shock Syndrome ◽

Complete Recovery ◽

Toxic Shock ◽

Paediatric Ward ◽

Royal Hospital ◽

Presenting Symptoms ◽

Inflammatory Syndrome ◽

Supportive Management ◽

Number Of Individuals

On 27 April 2020, the National Health Service England issued an emergency alert for a new condition owing to the observation of an increasing number of cases of a COVID-19-related hyperinflammatory syndrome termed multisystem inflammatory syndrome in children (MIS-C). Some of the presenting symptoms appeared similar to the Kawasaki disease and toxic shock syndrome. We report the cases of six children fitting the criteria of MIS-C, admitted to Royal Hospital and Sohar Hospital, Oman, between the months of June and July in 2020. Four of these patients required admission at the paediatric intensive care unit for inotropic support while two were admitted to the paediatric ward on suspicion of appendicitis. MIS-C has been reported in a small number of individuals below the age of 21 years with a median age of 9–10 years. Five of the current patients were aged less than the median age reported in the existing literature. All of the patients showed complete recovery with supportive management, intravenous immunoglobulin and steroids, with one patient requiring interleukin-6 inhibitor (tocilizumab). Keywords: COVID-19; SARS-CoV-2; Kawasaki Disease; Multisystem Inflammatory Syndrome in Children; Toxic Shock Syndrome; Case Report; Oman.

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Multisystem Inflammatory Syndrome in an Adult (MIS-A) Successfully Treated with Anakinra and Glucocorticoids

Microorganisms ◽

10.3390/microorganisms9071393 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1393

Author(s):

Paolo Cattaneo ◽

Alessandro Volpe ◽

Chiara Simona Cardellino ◽

Niccolò Riccardi ◽

Giulia Bertoli ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Picture ◽

Toxic Shock Syndrome ◽

Case Series ◽

Biologic Agents ◽

Diagnostic Process ◽

Cytokine Storm ◽

Toxic Shock ◽

Inflammatory Syndrome

During the current SARS-CoV-2 pandemic, a novel syndrome termed “multisystem inflammatory syndrome in children” (MIS-C) has emerged. MIS-C was linked to COVID-19 and shared some features with Kawasaki disease and Toxic Shock Syndrome, with a common pathogenetic substrate of hyperinflammation and cytokine storm. Lately, MIS was also described in adults (≥21 years of age) and named “MIS-A”. There is no consensus about the treatment of MIS-A; successful use of glucocorticoids and immunoglobulins has been reported in case series, but more solid evidence is lacking. Furthermore, the role of biologic agents with proven benefits against COVID-19, MIS-C, or Kawasaki disease is still unexplored. In this report, we detail the clinical picture and the diagnostic process that led to the diagnosis of MIS-A in a 27-year-old man, focusing on its treatment with anakinra and glucocorticoids, which resulted in full recovery. To our knowledge, this is the first report of the successful use of anakinra for MIS-A, a drug that has already proven useful in the treatment of refractive cases of MIS-C. Anakinra may also play a pivotal role for the treatment of MIS-A.

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Multisystem Inflammatory Syndrome in Children Associated with COVID-19: A Review with an Emphasis on Mucocutaneous and Kawasaki Disease-Like Findings

Dermatology ◽

10.1159/000515449 ◽

2021 ◽

pp. 1-9

Author(s):

Angelo Valerio Marzano ◽

Nicoletta Cassano ◽

Chiara Moltrasio ◽

Lucio Verdoni ◽

Giovanni Genovese ◽

...

Keyword(s):

Immune Response ◽

Kawasaki Disease ◽

Inflammatory Disease ◽

Toxic Shock Syndrome ◽

Toxic Shock ◽

High Prevalence ◽

Inflammatory Syndrome ◽

The Relationship

Background: COronaVIrus Disease 2019 (COVID-19) affects children with less severe symptoms than adults. However, severe COVID-19 paediatric cases are increasingly reported, including patients with Kawasaki disease (KD) or a multisystem inflammatory syndrome (MIS-C) that can present with features resembling KD. Summary: MIS-C is an emerging severe paediatric syndrome associated with COVID-19 that can show overlapping features of KD, KD shock syndrome, and toxic shock syndrome. MIS-C might be an inflammatory disease distinct from KD resulting from an exaggerated immune response. A high prevalence of mucocutaneous manifestations – in addition to gastrointestinal and cardiovascular involvements – was found in MIS-C. The most frequent mucocutaneous findings were conjunctivitis and rash, often described as macular and/or papular or polymorphous. In this article, we present a brief overview of MIS-C with an emphasis on mucocutaneous findings and the relationship with KD.

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Similarities and Differences Between COVID-19-Related Multisystem Inflammatory Syndrome in Children and Kawasaki Disease

Frontiers in Pediatrics ◽

10.3389/fped.2021.640118 ◽

2021 ◽

Vol 9 ◽

Author(s):

Min-Sheng Lee ◽

Yi-Ching Liu ◽

Ching-Chung Tsai ◽

Jong-Hau Hsu ◽

Jiunn-Ren Wu

Keyword(s):

United States ◽

Differential Diagnosis ◽

Kawasaki Disease ◽

Clinical Features ◽

Toxic Shock Syndrome ◽

The United States ◽

Toxic Shock ◽

First Case ◽

Similarities And Differences ◽

Inflammatory Syndrome

In December 2019, the first case of coronavirus disease (COVID-19) was first reported in Wuhan, China. As of March 2021, there were more than 120 million confirmed cases of COVID-19 and 2.7 million deaths. The COVID-19 mortality rate in adults is around 1–5%, and only a small proportion of children requires hospitalization and intensive care. Recently, an increasing number of COVID-19 cases in children have been associated with a new multisystem inflammatory syndrome. Its clinical features and laboratory characteristics are similar to those of Kawasaki disease (KD), KD shock syndrome, and toxic shock syndrome. However, this new disorder has some distinct clinical features and laboratory characteristics. This condition, also known as multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, has been observed mostly in Europe and the United States. This emerging phenomenon has raised the question of whether this disorder is KD triggered by SARS-CoV-2 or a syndrome characterized by multisystem inflammation that mimics KD. This narrative review is to discuss the differences between MIS-C and KD with the aim of increasing pediatricians' awareness of this new condition and guide them in the process of differential diagnosis.

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Multi-System Inflammatory Syndrome in Children (MIS-C), Kawasaki Disease and Toxic Shock Syndrome so Different and Similar

Journal of Biosciences and Medicines ◽

10.4236/jbm.2021.99007 ◽

2021 ◽

Vol 09 (09) ◽

pp. 74-86

Author(s):

Elda Skenderi ◽

Admir Sulovari ◽

Gjeorgjina Kuli-Lito ◽

Nilsa Shahini ◽

Griselda Toci ◽

...

Keyword(s):

Kawasaki Disease ◽

Toxic Shock Syndrome ◽

Toxic Shock ◽

Inflammatory Syndrome

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Infected abdominal aorta aneurysm secondary to streptococcal toxic shock syndrome due to Streptococcus pyogenes : a case report from Japan

Acute Medicine & Surgery ◽

10.1002/ams2.617 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Shiho Taniguchi ◽

Yukio Sato ◽

Naotaka Shimatani ◽

Yosaku Torii ◽

Mariko Sekimizu ◽

...

Keyword(s):

Case Report ◽

Streptococcus Pyogenes ◽

Abdominal Aorta ◽

Toxic Shock Syndrome ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Abdominal Aorta Aneurysm ◽

Aorta Aneurysm

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Neonatal Toxic Shock Syndrome–Like Exanthematous Disease in North America

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piz060 ◽

2019 ◽

Author(s):

Megan Culler Freeman ◽

Stephanie Mitchell ◽

John Ibrahim ◽

John V Williams

Keyword(s):

North America ◽

Diagnostic Criteria ◽

Skin Rash ◽

Toxic Shock Syndrome ◽

Disease Process ◽

Toxic Shock ◽

C Reactive Protein ◽

Reactive Protein ◽

First Case

Abstract Neonatal toxic shock syndrome (TSS)-like exanthematous disease (NTED) is a syndrome first reported in Japan. Neonates develop systemic exanthema, thrombocytopenia, and fever usually during the first week of life. The disease is distinguished from frank TSS because affected infants are not severely ill and do not meet TSS criteria. Most infants are confirmed to be colonized with TSST-1 producing strains of S. aureus. Suggested diagnostic criteria for NTED include a skin rash with generalized macular erythema and one of the following symptoms: fever >38.0°C, thrombocytopenia <150 x103uL, or low positive C-reactive protein (1-5 mg/dL) in the absence of another known disease process. NTED is common in Japanese NICUs, but outside Japan, only one case has been reported in France. We describe the first case of NTED reported in North America.

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