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COVID-19-associated multisystem inflammatory syndrome in children: Experiences of three centres in Turkey
Hakan Salman1, Nagehan Aslan2, Mustafa Akçam1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical School, Suleyman Demirel University, Isparta, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can be severe, often involving the gastrointestinal and neurological systems. Early recognition and appropriate treatment are crucial, as MIS-C can have a fatal outcome, and unnecessary surgeries should be avoided.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- The pathogenesis and clinical features of multisystem inflammatory syndrome in children (MIS-C) remain incompletely understood.
- There is no established consensus regarding the optimal treatment strategies for MIS-C.
- The emergence of SARS-CoV-2 has been associated with a rise in pediatric inflammatory conditions like MIS-C.
Purpose of the Study:
- To evaluate patients diagnosed with MIS-C.
- To contribute to the existing literature and enhance understanding of this novel pediatric condition.
- To share clinical experiences with MIS-C following the SARS-CoV-2 pandemic peak.
Main Methods:
- Retrospective analysis of 17 pediatric cases diagnosed with MIS-C.
- Adherence to diagnostic criteria established by the Centers for Disease Control and Prevention (CDC).
Main Results:
- Comorbidities were present in 41.2% of patients.
- Gastrointestinal involvement was the most common manifestation (70.6%).
- Neurological involvement was observed in two patients, and three underwent laparotomy for acute abdomen.
- Treatment included intravenous immunoglobulin (88.2%) and methylprednisolone (76.5%).
- Severe cases required mechanical ventilation or high-flow oxygen therapy; one patient died despite advanced life support.
Conclusions:
- MIS-C can present with severe gastrointestinal and neurological symptoms and may have a fatal course.
- Prompt diagnosis and management are essential for improving outcomes in MIS-C.
- Clinical vigilance is necessary to avoid potentially unnecessary surgical interventions like laparotomy.
Background:
The pathogenesis and clinical manifestations of the multisystem inflammatory syndrome in children (MIS-C) has not yet been fully elucidated and there is no clear consensus on its treatment yet.
Objectives:
To evaluate our patients diagnosed with MIS-C and present them to the literature in order to contribute to the better understanding of this new disease, which entered paediatric practice with the SARS-CoV-2 peak.
Methods:
In this study, 17 MIS-C cases diagnosed according to the Centers for Disease Control and Prevention criteria were included.
Results:
Of the patients, 7 (41.2%) had a comorbidity. Gastrointestinal system involvement was the most prominent in the patients (70.6%). Laparotomy was performed in 3 patients due to acute abdomen. Two patients had neurological involvement. Of the patients, 15 (88.2%) received intravenous immunoglobulin and 13 (76.5%) received both intravenous immunoglobulin and methylprednisolone. Two patients received invasive mechanical ventilation and 4 patients received high flow rate nasal cannula oxygen therapy. One of our patients who needed invasive mechanical ventilation and high vasoactive-inotrope support died despite all supportive treatments including plasmapheresis and extracorporeal membrane oxygenation.
Conclusions:
MIS-C picture can have a fatal course and may present with severe gastrointestinal and neurological signs. Unnecessary laparotomy should be avoided.
