Abstract
BackgroundMultisystem Inflammatory Syndrome in Children (MIS-C) is a rare hyperinflammatory condition that occurs following SARS-CoV-2 infection. There is a paucity of research describing risk factors, optimal management, and outcomes of this life-threatening condition.MethodsThis is a case series of 26 patients diagnosed with MIS-C in a West Michigan pediatric tertiary care center from April 2020 to February 2021. We describe the clinical, imaging, and laboratory characteristics of these patients and detail their treatments and outcomes with comparisons between Pediatric Intensive Care Unit (PICU) and non-PICU patients. Categorical testing utilized Chi-square and Fisher’s Exact tests. Comparison between groups used T-tests or Kruskal-Wallis.ResultsFifteen patients (57%) required intensive care. There was no statistically significant difference in demographics between PICU and non-PICU patients, however all Black patients required intensive care. Gastrointestinal symptoms were present in 22 patients (84%). Seventeen patients (65%) had Kawasaki-like features and 12 (46%) developed coronary artery dilation. Patients requiring intensive care were less likely to have a reported history of COVID-19 disease or exposure (p = 0.0362). Statistically significant differences were also noted in peak ferritin (p = 0.0075), procalcitonin, and BNP in those who required intensive care.ConclusionsAlthough overlap exists with other hyperinflammatory conditions, our study provides further evidence that MIS-C is a distinct, albeit heterogenous, disorder with various degrees of cardiac involvement. Anakinra, in conjunction with steroid use, appears to be effective and safe in the treatment of MIS-C. This report identifies procalcitonin, peak ferritin, and BNP as potentially useful biomarkers for severity of disease.
Highlights
Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare hyperinflammatory condition that occurs following SARS-CoV-2 infection
We developed a multidisciplinary protocol developed to assist in the diagnosis, evaluation, and treatment of MIS-C, modeled from American College of Rheumatology (ACR) guidelines [13]
Once identified as a possible case of MIS-C by clinical criteria, patients were evaluated with complete blood count with manual differential, comprehensive metabolic panel (CMP), as well as inflammatory markers
Summary
Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare hyperinflammatory condition that occurs following SARS-CoV-2 infection. As SARS-CoV-2 spread across the world into a global pandemic [1], London researchers recognized a new entity [6], originally described as a severe Kawasakilike disease noted in children across Europe, including Italy and the United Kingdom [7, 8]. This later became known as Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States [6]. The Shabab et al Pediatric Rheumatology (2021) 19:172
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