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Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with
Paulina Krawiec1, Violetta Opoka-Winiarska2, Elżbieta Pac-Kożuchowska1
1Department of Pediatrics and Gastroenterology, Medical University of Lublin, Racławickie 1, 20-059 Lublin, Poland.
Insights
Pediatric inflammatory multisystem syndrome (PIMS-TS/MIS-C) can mimic inflammatory bowel disease (IBD) flares in children. Differentiating these conditions presents significant diagnostic and treatment challenges due to overlapping gastrointestinal symptoms.
Area of Science:
- Pediatric rheumatology
- Pediatric gastroenterology
- Infectious diseases
Background:
- Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a severe complication of SARS-CoV-2 infection.
- Gastrointestinal symptoms are common in PIMS-TS/MIS-C, complicating diagnosis in children with existing inflammatory bowel disease (IBD).
Purpose of the Study:
- To describe clinical features and diagnostic/therapeutic challenges in children with overlapping IBD and PIMS-TS/MIS-C.
- To analyze the interplay between IBD exacerbations and PIMS-TS/MIS-C in a pediatric population.
Main Methods:
- Retrospective review of medical records of children hospitalized with overlapping IBD and PIMS-TS/MIS-C.
- Study conducted at a single pediatric hospital between December 2020 and December 2021.
Main Results:
- Four children with concurrent IBD flare and PIMS-TS/MIS-C were identified.
- PIMS-TS/MIS-C onset occurred during IBD therapy in most cases, with all presenting with gastrointestinal symptoms.
- Treatment included IVIG, ASA, and steroids in most cases; one child was vaccinated.
Conclusions:
- SARS-CoV-2 infection can trigger PIMS-TS/MIS-C in children with IBD, potentially exacerbating the underlying condition.
- The clinical similarity between PIMS-TS/MIS-C and IBD flares poses significant diagnostic and therapeutic hurdles.
Background:
Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. Gastrointestinal manifestations are prominent in children with PIMS-TS/MIS-C. Thus, it is challenging to differentiate this condition from an exacerbation of inflammatory bowel disease (IBD). We aimed to present the clinical characteristics, and diagnostic and therapeutic difficulties in patients with overlapping IBD and PIMS-TS/MIS-C; Methods: We reviewed medical records of children hospitalized due to overlapping IBD and PIMS-TS/MIS-C in a single pediatric hospital from December 2020 to December 2021; Results: There were four children with overlapping IBD flare and PIMS-TS/MIS-C. In three cases, IBD recognition preceded PIMS-TS/MIS-C onset and PIMS-TS/MIS-C occurred during anti-inflammatory therapy of IBD. All children presented with gastrointestinal symptoms at PIMS-TS/MIS-C onset. All patients received IVIG and ASA treatment. In three children there was a need to use steroids to resolve PIMS-TS/MIS-C symptoms. One child was vaccinated against COVID-19; Conclusions: SARS-CoV-2 infection may affect patients with underlying inflammatory conditions such as IBD, inducing systemic symptoms of PIMS-TS/MIS-C, and probably triggering IBD after PIMS-TS/MIS-C. The resemblance of clinical presentations is the main source of diagnostic and therapeutic challenges in PIMS-TS/MIS-C in patients with underlying IBD.
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