ABSTRACT
Introduction: It was recently observed and described an association between a pediatric hyperinflammatory state and the infection by SARS-CoV-2 which was named Multisystem inflammatory syndrome in children related to COVID-19 (PIMS- TS) or Multisystem inflammatory syndrome (in children) MIS-C. Objectives: We aimed our study at describing the clinical features, epidemiologic characteristics, management, and prognosis. Methods: This is a retrospective, descriptive and observational study performed at the Hospital Infantil de Mexico Federico Gomez, a thirdlevel children's hospital in Mexico City. The study includes all the cases that met criteria for PIMS-TS/MIS-C of the RCPCH, WHO, and/or CDC, that were diagnosed and treated between March 2020 and March 2021. We identified a total of 41 cases. Results: The depicted table describe the demographics of our studied population. The highest incidence was seen in previously healthy, school-aged children. No differences were noted based on sex. In 50% of the cases, there was history of exposure to COVID-19. 7.3% of patients had an associated comorbidity. The SARS-CoV2 was isolated from CSF in one patient with PIMS. There were no documented cases of macrophage activation syndrome (MAS). While coagulopathy was observed, there were no cases of disseminated intravascular coagulation (DIC). These results are consistent with the results reported by Hoste L et al. Eur J Pediatr. 2021. Conclusion: The present study depicts the experience of our institution with the new nosological entity named PIMS. We highlight the null mortality, the effectiveness of steroids and gammaglobulin in lieu of biologic therapy as part of the management, and the predominance of previously healthy patients without significant comorbidities. We consider this a broad evaluation, as our sample size consisted of 41 patients from the same location.
ABSTRACT
Objectives: To describe the case of a patient with pediatric multisystemic inflammatory syndrome with neurological compromise due to SARS-COV-2. Methods: Descriptive and observational case. Data obtained from the medical records. Results: 4-month-old girl. Epidemiological contact: maternal grandfather with COVID-19 4 weeks previously. Clinical history: 5-day fever (40 ° C), irritability, sporadic cough, generalized maculopapular rash, non-suppurative conjunctivitis, edema of the hands and feet. On admission irritable, drowsy, bulging anterior fontanelle, tachycardia, bulging pulses, flash capillary filling. He required oxygen, crystalloid loads, and admission to intensive care. It was integrated (PIMS) and meningoencephalitis. Cerebrospinal fluid (CSF): protein spinal cord and leukocytosis, SARS COV2 positive in CSF and serum. Echocardiogram, chest X-ray film and head tomography without abnormalities. Treatment: gamma globulin (2 g/kg/d), methylprednisolone (2 mg/kg/d) and enoxaparin (1 mg/kg/d). Discharged without sequelae 6 days after hospitalization. Some laboratory results are shown in Table 1. Conclusion:We report the exceptional case of SARS-COV-2 meningoencephalitis with positive PCR in the CSF. Comprehensive evaluation of the patient with neurological compromise due to SARS-COVS-2 must be thorough. PIMS is associated with lethargy and drowsiness. In the present case, the relevant clinical data was irritability. A comprehensive approach to the patient is imperative given the diversity of the infectious behavior of sars-cov-2.