Multi-system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia: Clinical perspective from a case series

Medicine (Baltimore). 2021 Jun 4;100(22):e25919. doi: 10.1097/MD.0000000000025919.

Abstract

Most of the reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children reported mild-to-moderate disease manifestations. However, recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS-CoV-2 infection termed multisystem inflammatory syndrome in children (MIS-C).The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS-C associated with SARS-CoV-2 infection. They were admitted to the pediatric intensive care unit (PICU). Their clinical presentation, laboratory, and outcome were described.All patients shared similar clinical presentations such as persistent documented fever for more than 3 days, respiratory symptoms, gastrointestinal involvement, and increased inflammatory markers (CRP, ESR, and ferritin). Three patients had concurrent positive coronavirus disease 2019 (COVID-19) infection, and the other 2 patients had contact with suspected COVID-19 positive patients. They were all managed in the PICU and received intravenous immunoglobulin, systemic steroid, and hydroxychloroquine. The hospital stays ranged between 3 and 21 days. One patient died due to severe multiorgan failures and shock, and the other 4 patients were discharged with good conditions.Pediatric patients with SARS-CoV-2 are at risk for MIS-C. MIS-C has a spectrum of clinical and laboratory presentations, and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes. Long-term follow-up studies will be required to explore any sequelae of MIS-C, precisely the cardiovascular complications.

Publication types

  • Observational Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • COVID-19 / epidemiology*
  • COVID-19 / physiopathology*
  • COVID-19 Drug Treatment
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunoglobulins / therapeutic use
  • Inflammation Mediators / metabolism
  • Intensive Care Units, Pediatric
  • Length of Stay
  • Male
  • Prospective Studies
  • SARS-CoV-2
  • Saudi Arabia / epidemiology
  • Severity of Illness Index
  • Systemic Inflammatory Response Syndrome / drug therapy
  • Systemic Inflammatory Response Syndrome / epidemiology*
  • Systemic Inflammatory Response Syndrome / physiopathology*

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Immunoglobulins
  • Inflammation Mediators
  • Hydroxychloroquine

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related