ABSTRACT
Background: Pediatric Infammatory Multisystemic Syndrome associated to SARS-CoV2 (PIMS) happens 4 to 6 weeks after SARS-CoV2 infection1-2. Its early diagnostic recognition as well as its early management is important to avoid cardiac complications related to this pathology. Objectives: To highlight a frequent symptom in PIMS and improve its therapeutic care. Methods: The JIR Cohort database, an international registry collecting data on patients with pediatric infammatory diseases, was consulted to include patients between 03/15/20 and 12/31/2021. Results: Of the 140 patients in whom a diagnosis of PIMS was retained, we present a series of 38 patients (27%) who presented at diagnosis or during evolution, febrile torticollis or painful cervical involvement. These patients were on average 8.2 years old (0.6-15.2). The proportion of boys was 14 out of 38 (37%). Twenty-four patients out of 33 (73%) were hospitalized in intensive care. Ten patients out of 38 (26%) underwent cervical imaging, 5 (50%) had abnormalities such as collection or infltration of the soft tissues. At the therapeutic level, 27/38 patients (71%) received corticosteroid therapy, 33/38 (87%) immunoglobulins, and 26/38 (68%) antibiotic therapy. Conclusion: PIMS is a pathology with signifcant clinical heterogeneity and severe consequences in case of delay in therapeutic management. In this epidemic context, it is important to consider PIMS in any patient with febrile torticollis, especially if he does not respond to antibiotics.
ABSTRACT
Background: Paediatric infammatory multisystem Syndrome (PIMS) is a new systemic infammatory disease linked to SARS-CoV2 that affects children. It was frst reported in may 2020 [1-2]. Objectives: The objectives of this study were to describe patients with PIMS through the international JIR cohort registry and to compare the different profiles and treatments of these patients over the different waves. Methods: Study patients with international PIMS criteria were included from March 2020 to June 2021. Patients were identifed in the JIR cohort, an international registry collecting demographic, clinical and paraclinical data on patients with pediatric infammatory diseases. Two groups were distinguished: from March 2020 to July 2020 for patients in the frst wave, from July 2020 to June 2021 for patients in the 2nd and 3rd waves. These two groups were compared using a Fischer test for categorical data and a Mann-Whitney test for quantitative data Results: 136 patients meeting the PIMS criteria were included (64 patients in the 1st wave, 72 patients after). Patients had less frequent myocarditis (51 patients in wave 1 vs. 36 patients after, p=0,0003) and respiratory distress (34 patients vs 10 patients, p<0,0001). Corticosteroids were used more frequently in the second wave (32 patients in wave 1 vs. 67 patients after July 2020, p<0,0001). Intravenous immunoglobulins were used as much over the waves (58 patients in wave 1 vs 68 patients after, p=0.5). Antibiotics were less used since the second wave (53 patients received antibiotics before July 2020 vs 11 after, p<0,0001). The duration of hospitalization decreased sig-nifcantly (p<0,0001) with a median duration of 9 days during the frst wave (interquartile range, 7-12) and 7 days (interquartile range, 5-10) after the frst wave. Conclusion: There was a decrease in the number of complications of PIMS, particularly cardiac and respiratory complications, and a decrease in the length of hospitalization over time. The treatment of PIMS has also evolved, with a clear increase in the use of corticosteroids and a decrease in the use of antibiotics.