Journal Article

SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment

Abdel-Haq Nahed, Ahmad, Charaf Eddine, Deza Leon Maria P, Tilford, Bradley, Sethuraman Usha, Asmar, Basim I, McGrath, Eric J, Arora, Harbir S, Cashen, Katherine, Ang, Jocelyn Y

2021

Overview

This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children’s Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)–like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered.Conclusion: MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome.What is Known:• Multisystem inflammatory syndrome in children (MIS-C) manifestations include fever, gastrointestinal symptoms, shock, and occasional features of Kawasaki disease (KD).• Treatment includes immunomodulatory agents, most commonly IVIG and corticosteroids.What is New:• Spectrum of MIS-C varies from mild to severe inflammation and coronary artery dilatation occurred in 5/22 (23%) critically ill patients.• IVIG and infliximab therapy were associated with a favorable outcome including resolution of coronary dilatation; only 2/33 received corticosteroids.

• Publisher: Springer Nature B.V
• Subject: Children / Coronary artery / Coronary vessels / Corticosteroids / Fever / Hypotension / Immunoglobulins / Immunomodulation / Inflammation / Infliximab / Intravenous administration / Kawasaki disease / Medical records / Monoclonal antibodies / Mucocutaneous lymph node syndrome / Multisystem inflammatory syndrome in children / Patients / Severe acute respiratory syndrome coronavirus 2 / TNF inhibitors / Tumor necrosis factor-α