Severe COVID-19 Complication Can Present Differently in Children

A stepwise approach to treatment for multisystem inflammatory syndrome, beginning with initiation of immunomodulatory drugs, was successful in all patients included in the study.

When assessing pediatric patients with COVID-19 who may have multisystem inflammatory syndrome (MIS-C), clinicians should make patient-based decisions and apply a stepwise approach to treatment, according to new research.

MIS-C is a rare and severe complication of COVID-19 first identified by the CDC in May 2020 with a wide spectrum of clinical presentation, according to the study authors. Children presenting with MIS-C can develop clinical features resembling other inflammatory conditions. MIS-C requires aggressive treatment and management, although it can be controlled and end-organ damage can be prevented.

It can range from mild, self-limited disease to severe systemic inflammation and multisystem organ involvement. Currently recommended treatment strategies include intravenous immunoglobulin (IVIG) alone or in combination with corticosteroids and other biological agents.

In an effort to better understand the condition, investigators performed a retrospective study of patients with MIS-C between August 2020 and March 2021 at Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital in Turkey. A total of 45 patients were included, 23 of whom were male, and with a median age of 8.7 years.

The serology for SARS-CoV-2 was positive in 95% of the patients. Organ-system involvement included the dermatologic in 41 (91%) patients, cardiovascular in 39 (87%) patients, hematologic in 36 (80%) patients, and gastrointestinal in 36 (80%) patients. Acute anterior uveitis was identified in 9 (20%) patients.

According to the paper, children with MIS-C can have variable presentations. Two patients in the study presented with clinical findings of deep neck infection, such as fever, neck pain, trismus, swelling, and induration on the cervical lymph node. One patient was diagnosed with Henoch-Schonlein purpura (HSP)-like eruption, and coronary artery dilation was detected in 5 (11%) patients.

IVIG was used in 44 (98%) of the patients, methylprednisolone in 27 (60%) of the patients, and anakinra in 9 (20%) of the patients. The median duration of hospitalization was 9 days and all patients recovered.

The authors did note, however, that their study had several limitations, specifically a low sample size, including retrospective data from a single center.

Based on these findings, the authors said different clinical manifestations can be found in patients with MIS-C, although they emphasized the presentations of symptoms mimicking deep neck infection and HSP-like rash. They also noted that the stepwise approach to treatment with the initiation of immunomodulatory drugs was successful in their study.

REFERENCE

Sen ZS, Tanir G, Cinni RG, Yazici MU, et al. Multisystem inflammatory syndrome in children during severe acute respiratory syndrome coronavirus-2 pandemic in Turkey: A single-centre experience. Journal of Pediatrics and Child Health. August 3, 2021. Accessed August 5, 2021. https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15674