Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection: A Single Center Experience

Abstract

Objective − To assess diagnostic criteria, laboratory findings and response to therapy among children with multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection.

Patients and Methods − retrospective study at the Clinic for Children’s Diseases Tuzla in the period November 2020-April 2021.

Results − 13 children fulfilled diagnostic criteria, median age 7.2 years, 5 were treated at the intensive care unit; one with lethal outcome. The most common symptoms and signs were: unremitting fever (100%), skin rash (84.6%), gastrointestinal symptoms (76.9%), pneumonia (92.3%); one girl required invasive mechanical support. Cardiac manifestations were present in 76.9%, one of three children with acute kidney injury required hemoperfusion. Altered mental status was present in 69.2%. Inflammatory markers were elevated and we found strong correlation between IL-6 and procalcitonin (rs=0.85), CRP and IL-6 (rs=0.70), and medium correlation between ferritin and procalcitonin (rs=0.53), ferritin and IL-6 (rs=0.52) values. Clinical improvement and a drop in inflammatory markers were seen within the first
48 to 72 hours of initiating IVIG and corticosteroid therapy (7/13 children), but it was also evident with corticosteroids alone (6/13 children).

Conclusion − MIS-C is a potentially fatal condition with very different presentations and strong inflammatory response. The key for a positive outcome is early recognition of MIS-C and adequate and prompt treatment.