AB1235 MULTISYSTEM INFLAMMATORY DISEASE IN CHILDREN (MIS-C) IN SINGAPORE CHILDREN: ARE WE DIFFERENT?

Abstract

BackgroundMultisystem Inflammatory Syndrome in Children (MISC) is a hyper-inflammatory state with similarities to Kawasaki Disease, 4 to 6 weeks after Covid-19 infection1. Literature describes a 11:1 Relative Risk for Asian children versus Caucasians2. Since the start of the pandemic, 17,699 children under 12 years were infected with Covid-193.ObjectivesTo describe presentation and short term outcomes, for a cohort of children with MIS-C at the sole Children’s Hospital in Singapore.MethodsDemographic and clinical/lab data were collected from children diagnosed with MIS-C accrording to the WHO criteria4 at KK Woman’s and Children’s Hospital, Singapore. Nonparametric descriptive statistics were used to describe and analyse data.ResultsEleven patients were diagnosed with MIS-C between October 2021 and Jan 2022. Seven (64%) were male and 4 (36%) were Chinese, with median age at presentation was 8.08 years (IQR 4.54 - 9.79). All patients had positive COVID-19 serology at the time of diagnosis. Median duration of fever prior to diagnosis was 5 days (IQR 4 - 5); Nine (82%) had gastrointestinal symptoms and median number of Kawasaki Disease (KD) features were 2 (IQR 2 - 3.5); common manifestations were conjunctivitis (90%), red lips (55%) and rash (36%). Of note, 8 (70%) patients had KD type peeling on follow-up. No BCGitis was found during acute phase. Seven (64%) were admitted to higher dependency care.Table 1, all patient received IVIG and IV steroids; 6 (55%) as pulse (30mg/kg/day) therapy. Patient 8, additionally received Anakinra. Median duration of admission was 6 days (IQR 5-13). One patient developed complications post therapy and was re-admitted to hospital for hematochezia. Treatment involved stopping Enoxaparin and Prednisone. Aspirin was resumed as soon as bleeding ceased. Laboratory characteristics and outcomes are denoted in Table 1. All patients had a monophasic course during the median of 10 weeks (IQR 8 - 11.5) of follow-up.Table 1.NoAge (yr)GI symptomsKD featuresHemoglobin (g/DL)Absolute Lymphocyte (10x9/L)Platelet (10x9/L)CRP (mg/L)D-Dimer (mg/L FEU)Ferritin (ug/L)Enoxaparin startedPeelingAbnormal echo110YES212.20.2367173.2323179.1YESYESYES211NO214.8116694.92.51350NOYESYES34.25YES210.41.02241134.66.05277.2YESNOYES47.67YES5110.41102250.69.323607.6YESYESNO58.58YES411.40.5693105.61.31846.6NOYESNO64.58YES210.33.09198137.41.87291NONONO79.58YES312.21.311191842.51244.3NOYESNO84.5YES411.90.45102181.811.121798.4YESNOYES911YES110.11.235974.24.531445.8YESYESNO103.42NO29.11.09138153.98.66609.4YESYESNO118.08YES211.41.2510166.81.31521.8NOYESYESConclusion1.Asian prevalence of MIS-C is not as high as that reported from the West. Similarities in presentation as to age and gender were noted.2.Most of our MIS-c patients developed periungual peeling at follow up, similarly to Kawasaki Disease.3.Different from our typical KD population, no BCG site inflammation was found.