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Post-COVID-19 Multisystem Inflammatory Syndrome in Children and Adults: What Happens After Discharge?
Michael Loncharich1, Seth Klusewitz2, Olcay Jones3
1Rheumatology, Walter Reed National Military Medical Center, Bethesda, USA.
Insights
Multisystem Inflammatory Syndrome (MIS) outpatient management showed good outcomes with short-term medication use. Children generally had better recovery than adults, suggesting early combination therapy may be beneficial.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Limited data exists on outpatient management and clinical outcomes for Multisystem Inflammatory Syndrome (MIS).
- Existing guidelines focus on inpatient care, leaving a gap in understanding long-term recovery for MIS patients.
- Multisystem Inflammatory Syndrome (MIS) is a serious condition that can affect multiple organs.
Purpose of the Study:
- To describe the outpatient management and clinical outcomes of children and adults with Multisystem Inflammatory Syndrome (MIS).
- To evaluate the effectiveness of short-term medication regimens in MIS patients.
- To compare outcomes between pediatric and adult MIS patients.
Main Methods:
- A retrospective case series of eight patients (four children, four adults) diagnosed with MIS.
- Data collected from SARS-CoV-2 exposure to six months post-MIS diagnosis.
- Included demographics, comorbidities, presentation, inpatient/outpatient treatment, and clinical outcomes.
Main Results:
- 62.5% of patients presented in shock; pediatric patients received combination therapy (IVIG, methylprednisolone, anakinra) not given to adults.
- Medications were discontinued within 1-2 months for most patients.
- Full recovery occurred in 75% of children and 50% of adults; persistent symptoms included deconditioning and dyspnea.
Conclusions:
- Multisystem Inflammatory Syndrome (MIS) appears monophasic with no recurrences at six months in this cohort.
- Short-term (1-2 months) glucocorticoid or immunomodulatory medication was sufficient for most patients.
- Better outcomes in children suggest potential benefits of early combination therapy or inherent physiological differences compared to adults.
Abstract:
Introduction Classification criteria and practice guidelines for inpatient management of multisystem inflammatory syndrome (MIS) exist, but reports on outpatient management and clinical outcomes are lacking. Here we describe the management and clinical outcomes of four children and four adults with MIS seen at Walter Reed National Military Medical Center (WRNMMC) from diagnosis to six months follow-up. Methods This retrospective, case-series describes the initial presentation and management of MIS in four children and four adults seen at WRNMMC from March 2020 to September 2021. Data on each patient was collected from the time of exposure to the SARS-CoV-2 virus to six months post-diagnosis with MIS. Extracted data includes: demographics, comorbidities, initial MIS presentation, inpatient treatment, outpatient treatment, and clinical outcomes. Results A total of 62.5% of patients presented in shock. All pediatric patients received IVIG, methylprednisolone, and anakinra; no adult received this combination. Steroids and immunomodulatory medications were discontinued in 1-2 months outpatient. Three children and two adults had full symptomatic resolution. One child and two adults had persistent deconditioning at six months follow-up. One adult had persistent dyspnea. Conclusions MIS appears to be monophasic with no recurrences at six months follow-up in our patients who only required 1-2 months of glucocorticoid or immunomodulatory medications. The better outcomes in children raise the question of how much of this difference can be attributed to early combination therapy versus physiologic differences in children and adults.
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