Inflammatory Syndrome
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2021 ◽  
Vol 9 ◽  
Ana Generalić ◽  
Maša Davidović ◽  
Ivanka Kos ◽  
Kristina Vrljičak ◽  
Lovro Lamot

Introduction: While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C). Published definition and criteria of MIS-C include persistent fever, multisystem involvement, and elevated markers of inflammation, without obvious microbial inflammation or other plausible diagnosis. However, the aim of this case report is to emphasize the diversity of symptoms of MIS-C, beyond the defined criteria.Case Presentation: We present a 10-year-old boy with 8p23.1 microdeletion syndrome and multiple comorbidities who initially came to our attention due to hematuria, persistent fever, rash, and elevated markers of inflammation. Within the next 2 days, his condition worsened despite the broad-spectrum antibiotic therapy. Assuming his past history of SARS-CoV-2 exposure, MIS-C was suspected. A high level of clinical suspicion was further supported by significant clinical features (vomiting, abdominal pain, conjunctivitis, arrhythmia, and mild left ventricular systolic dysfunction with pleural effusion) along with laboratory findings (elevated ESR, CRP, proBNP, D-dimers and fibrinogen, positive IgG SARS-CoV-2 antibodies, and negative microbiological cultures). The patient was given intravenous immunoglobulin (IVIG) and began to show instantaneous clinical and laboratory improvement.Conclusion: Despite numerous reports of MIS-C cases in children, there are still many uncertainties regarding the clinical presentation and laboratory findings, as well as mechanisms beyond this intriguing disorder. In our case, for the first time hematuria is reported as an early symptom of MIS-C. We strongly believe that reporting various manifestations and outcomes in MIS-C patients will lead to improved diagnosis, treatment, and overall understanding of this novel inflammatory condition.

2021 ◽  
Vol 69 (1) ◽  
Haneen K. Morsy ◽  
Noha S. Tohamy ◽  
Hager M. Abd El Ghaffar ◽  
Rana Sayed ◽  
Nagwa A. Sabri

Abstract Background and objectives Children suffering from coronavirus disease (COVID-19) usually present with mild symptoms and show lower mortality rates than adults. However, there have been several recent reports of more severe hyperinflammatory presentation in pediatric COVID-19 patients. This review article aims to summarize the current literature available on the main clinical features and management approaches of multisystem inflammatory syndrome in children (MIS-C). Methods The authors searched different indexing databases for observational and interventional studies using search terms including “Coronavirus, COVID-19, pediatric, MIS-C, Kawasaki, and inflammation.” The retrieved publications were further assessed for relevance to the topic. Only relevant articles were included in writing this review article. Main body Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome temporally related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in pediatrics. It is characterized by persistent fever, rash, elevated inflammatory markers, and multiorgan failure with increasing rates of cardiovascular and gastrointestinal involvement. The exact pathophysiologic mechanisms of MIS-C are still unknown, but it is postulated to be due to an exaggerated immune response to SARS-CoV-2 infection. Multisystem inflammatory syndrome in children is diagnosed by exclusion of other underlying causes of organ failure. There is a lack of clinical evidence on the management of MIS-C. The current guidelines depend mainly on expert opinion based on the management of other hyper-inflammatory syndromes in children. Patients suffering from MIS-C are treated with intravenous immunoglobulin (IVIg), corticosteroids, infliximab, tocilizumab, and anakinra. Conclusions Despite the growing reports on COVID-19 in children, there is still a lot to elucidate on the pathophysiology, diagnosis, and subsequent management of MIS-C. Further trials are needed to investigate new approaches to manage MIS-C. Specific evidence-based guideline for management of MIS-C should be tailored to the current available information on MIS-C.

2021 ◽  
Vol 9 ◽  
Celia Guenver ◽  
Mehdi Oualha ◽  
Corinne Levy ◽  
Denise Antona ◽  
Fouad Madhi ◽  

Background: Multisystem inflammatory syndrome in children (MIS-C) is the most severe form associated with SARS-CoV-2 infection in children. To reduce the spread of SARS-CoV-2 at the population level, educational setting closure have been implemented in many countries. However, the direct benefit of school closure on the MIS-C burden remains to be explored. We aimed to assess the role of educational settings in SARS-CoV-2 transmission among children with MIS-C.Methods: We conducted a French national prospective surveillance of MIS-C, coordinated by Public Health France, from April 2020 to March 2021. During this period, we included all children with MIS-C fulfilling the WHO definition who were reported to Public Health France. For each child, we traced the source of SARS-CoV-2 transmission. The main outcome was the proportion of children with MIS-C, with educational setting-related SARS-CoV-2 infection, during the period of school opening.Results: We included 142 children fulfilling WHO criteria for MIS-C: 104 (70%) cases occurred during school opening periods. In total, 62/104 children (60%, 95%CI [50; 69]) had been contaminated by a household contact and 5/104 in educational settings (5%, 95%CI [2; 11]). Among children with MIS-C occurring during school closure periods, the proportion of household transmission remained similar (66%, 25/38).Conclusion: Children with MIS-C were mainly infected by SARS-CoV-2 within their family environment, and the educational setting played a marginal role in this transmission. This suggests that mitigating school attendance may not reduce substantially the burden of MIS-C.

2021 ◽  
pp. 1-8
Angelo Valerio Marzano ◽  
Nicoletta Cassano ◽  
Chiara Moltrasio ◽  
Lucio Verdoni ◽  
Giovanni Genovese ◽  

<b>Hintergrund:</b> Die Symptome der Coronavirus-Infektion 2019 (COronaVIrus Disease 2019, COVID-19) fallen bei Kindern weniger schwer aus als bei Erwachsenen. Allerdings liegen zunehmend Berichte über schwere pädiatrische COVID-19-Fälle vor, darunter Patienten mit Kawasaki-Syndrom (KS) oder einem multisystemischen Entzündungssyndrom (multisystem inflammatory syndrome in children, MIS-C), das KS-ähnliche Merkmale aufweisen kann. <b>Zusammenfassung:</b> MIS-C ist ein neuartiges schweres pädiatrisches Syndrom, das mit COVID-19 in Zusammenhang steht, und bei dem Überschneidungen mit KS, KS-Schocksyndrom und toxischem Schocksyndrom bestehen können. Möglicherweise handelt es sich bei MIS-C um eine entzündliche Erkrankung, die sich vom KS unterscheidet und Folge einer überschießenden Immunreaktion ist. Neben einer gastrointestinalen und kardiovaskulären Beteiligung wurde bei MIS-C auch eine hohe Prävalenz von mukokutanen Manifestationen beobachtet. Die häufigsten mukokutanen Befunde waren Konjunktivitis und Exanthem, das oft als makulös und/oder papulös oder polymorph beschrieben wurde. In der vorliegenden Arbeit geben wir einen kurzen Überblick über MIS-C mit besonderem Augenmerk auf mukokutanen Befunden und dem Zusammenhang mit KS.

2021 ◽  
Vol 8 (11) ◽  
pp. 1890
Alekhya Erubothu ◽  
Sudha Rudrappa ◽  
Pratibha Manjunath Patagar

Multi-system inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 is a new entity affecting a small percentage of children during the COVID-19 pandemic. This usually presents with multi-organ dysfunction, predominantly affecting cardiovascular, muco-cutaneous, and gastrointestinal systems. Till now, neurological manifestations as a part of this spectrum, such as, encephalopathy, inflammatory CNS syndromes, cerebrovascular disease, and Guillain-Barré syndrome (GBS), have been well reported in adults, but there is a paucity of data from the paediatric age group. Here, we present a case of a 6-year-old girl who presented to us with progressive, bilaterally symmetrical ascending weakness of lower limbs followed by upper limbs along with drooling of saliva and dyspnea. Nerve conduction studies showed motor axonal neuropathy suggestive of GBS and child was treated accordingly with intravenous immunoglobulin. On 4th day of admission, the child developed high grade fever spikes, hypotension and diarrhoea. Hence, worked up for MIS-C which revealed elevated inflammatory markers with positive SARS-CoV-19 IgM, IgG antibodies. The diagnosis was hence revised to GBS with MIS-C, the child was then started on methylprednisolone following which the child showed both clinical and biochemical improvement and was then discharged. A high index of suspicion for the possibility of MIS-C should be kept in mind in the present pandemic times, as the immune-mediated damages in MIS-C are potentially treatable with a timely institution of intensive care measures along with the use of steroids, IV-Ig, and plasmapheresis.

2021 ◽  
Vol 9 (1) ◽  
pp. 051-053
Swati Kapoor ◽  
Ashutosh Bhardwaj ◽  
Gitali Bhagawati ◽  
SM Quadri

Multi inflammatory syndrome (MIS) is a rare complication associated with covid-19 with few cases reported in pediatric age group. This entity is not well studied in adults. We report a case of a young male presented to us in very critical condition and was diagnosed as a case of MIS-A (Multi Inflammatory Syndrome - Adult). He was successfully treated with intravenous immunoglobulin, steroids and other supportive measure. By correct and timely diagnosis of this entity, one can prevent fatal outcome.

Narendra Kumar Bagri ◽  
Rakesh Kumar Deepak ◽  
Suneeta Meena ◽  
Saurabh Kumar Gupta ◽  
Satya Prakash ◽  

2021 ◽  
Vol 12 ◽  
Omar Graciano-Machuca ◽  
Geannyne Villegas-Rivera ◽  
Iván López-Pérez ◽  
José Macías-Barragán ◽  
Sonia Sifuentes-Franco

With the appearance of the SARS-CoV-2 virus in December 2019, all countries in the world have implemented different strategies to prevent its spread and to intensively search for effective treatments. Initially, severe cases of the disease were considered in adult patients; however, cases of older school-age children and adolescents who presented fever, hypotension, severe abdominal pain and cardiac dysfunction, positive for SARS-CoV-2 infection, have been reported, with increased pro-inflammatory cytokines and tissue damage, condition denominated multisystemic inflammatory syndrome (MIS-C); The emerging data from patients with MIS-C have suggested unique characteristics in the immunological response and also clinical similarities with other inflammatory syndromes, which can support as a reference in the search for molecular mechanisms involved in MIS-C. We here in propose that oxidative stress (OE) may play a very important role in the pathophysiology of MIS-C, such as occurs in Kawasaki disease (KD), severe COVID-19 in adults and other processes with characteristics of vascular damage similar to MIS- C, for which we review the available information that can be correlated with possible redox mechanisms.

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