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Published on: September 7, 2022
[COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru]
Liz E De Coll-Vela1,2, Mariela K Zamudio-Aquise1,3, Héctor Nuñez-Paucar1,2
1Instituto Nacional de Salud del Niño Breña, Lima, Perú.
Insights
Multisystem Inflammatory Syndrome in children (MIS-C) presents uniquely in pediatric patients. Early investigation is crucial for children with fever, GI, and dermatological symptoms post-SARS-CoV-2 exposure.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic introduced Multisystem Inflammatory Syndrome in children (MIS-C), a novel pediatric condition.
- Understanding MIS-C's diverse clinical spectrum and outcomes is critical for effective management.
Observation:
- Eight pediatric patients in Lima, Peru, diagnosed with MIS-C were analyzed.
- Mean age was 5.1 years, presenting with fever, gastrointestinal, ocular, and mucocutaneous symptoms.
- Four patients met criteria for Kawasaki Disease; four met criteria for Macrophage Activation Syndrome.
Findings:
- All patients had SARS-CoV-2 serology positivity, abnormal blood counts, coagulation, and elevated inflammatory markers.
- Elevated liver enzymes (5/8) and kidney involvement (3/8) were observed.
- While most recovered, one experienced myocarditis and shock, requiring Pediatric Intensive Care Unit admission; no coronary aneurysms were noted.
Implications:
- Children presenting with fever, GI, and dermatological symptoms after SARS-CoV-2 exposure require thorough investigation for MIS-C.
- Prompt diagnosis and management, including IVIG, corticosteroids, and aspirin, are vital for favorable outcomes.
- This study highlights the importance of recognizing MIS-C's varied presentations in pediatric populations.
Abstract:
During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.
