Multisystem Inflammatory Syndrome and acute myocarditis after SARSCoV-2 in Children - Case Descritpion and Review of the Literature

Symptoms of acute Covid-19 infection are less common in children than in adults. In most cases, the symptoms are mild or absent. However, after contact with SARS-CoV-2, children may develop post-infectious hyperinflammatory syndrome - multisystem inflammatory syndrome in children (Multisystem Inflammatory Syndrome in Children MIS-C). We present 6 children with MIS-C, observed in November and December 2020 during the peak incidence of Covid-19 infection in Bulgaria. Patients have a mean age of 9.7 years. Four of the children had a history of contact with Covid-19. Clinically, they presented with fever and gastrointestinal symptoms. SARSCoV2 IgM and IgG serology was positive in all patients. Troponin and pro-BNP (B-type natriuretic peptide) levels were elevated in all six children. Cardiac ultrasound revealed systolic dysfunction of the left ventricle (reduce ejection fraction) in all of them. When cardiac MRI was performed, limited areas of left ventricular myocardial edema, as well as areas of late non-ischemic gadolinium amplification involving up to 25% of the myocardium, were founded. Treatment in all patients includes a broad-spectrum antibiotic, intravenous immunoglobulin, corticosteroids, diuretic, ACE inhibitor, and low molecular weight heparin. At discharge, all patients were in good overall condition, with no signs of heart failure, normal echocardiographic findings, and laboratory tests. In children the mortality from MIS-C is not high, despite significant increase in inflammatory markers and multisystem symptoms. In our patients, the short term outcome of MIS-C is favorable. However, long-term follow-up is needed for late complications. © 2021 Academy of Medicine. All rights reserved.

Sars-cov-2 infection and musculoskeletal manifestations

An overview of the frequency of musculoskeletal manifestations of COVID-19 infection' their relationship to fever' inflammatory activity and pulmonary manifestations' as well as their duration is presented. COVID-19 is a global pandemic that mainly affects the respiratory tract' but also has a multi-stakeholder impact. Complaints of the musculoskeletal system are described in 15-36% of cases' but the clinical characteristics and consequences are currently unspecified. Musculoskeletal symptoms are divided into: myalgia' arthralgia' back pain and generalized body pain. Arthritis is an unusual manifestation of COVID-19' rarely observed' with unspecified pathogenesis. The mechanisms of arthralgia in COVID-19 are currently unknown. Direct invasion of the synovium or deposition of immune complexes is suggested. MS symptoms are not associated with a risk of developing pneumonia. Patients with musculoskeletal symptoms were more likely to have fever (p < 0.01) and higher CRP values (p < 0.01). Respiratory symptoms are similar in patients with and without musculoskeletal symptoms. MS symptoms are not associated with an unfavorable outcome of the infection.

Multisystem inflammatory syndrome in children-well-known disease or new entity and the experience of pediatric rheumatology department' sofia

Compared with adults' children develop only mild or no symptoms of acute COVID-19 infection. However' exposed to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus type 2)' post-infectious hyperinflammatory syndrome can develop-Multisystem Inflammatory Syndrome in Children (MIS-C). Multisystem inflammatory syndrome in children develops 2-6 weeks after SARS-CoV2 infection. There is a discussion in the medical society whether this is a new disease entity or an expression of a well-known one. To report the demographic' clinical and laboratory characteristics' the treatment and evolution of children with multisystem inflammatory syndrome who were admitted to the Department of pediatric rheumatology' cardiology and hematology at Pediatric Hospital 'Prof. Ivan Mitev' for the period November 2020-July 2021. 14 children were hospitalized-8 girls and 6 boys with a mean age of 7.4 years. Seven of the children were admitted within 3 months after the first peak of coronavirus infection for the country. The remaining half of the children were hospitalized within 3 months after the second peak of coronavirus infection in Bulgaria. The mean period between initial onset of symptoms and hospitalization was 5.64 days. All children had fever at admission. Leading symptoms were mucocutaneous symptoms observed in 13/14 children and abdominal symptoms in 10/14 children. Myocardial involvement was reported in 11 of the patients' requiring inotropic support in 5 of them. One of the patients had acute renal failure on admission. Positive serology for SARS-CoV2 was detected in all 14 children. Combination of intravenous immunoglobulin and corticosteroid was administered to all patients with complete reversal of symptoms during follow up. Most commonly observed clinical manifestations in the described patients with multisystem inflammatory syndrome were fever' mucocutaneous and abdominal symptoms. In a large proportion (10/14) of patients' myocardial involvement was also detected. Timely treatment and follow up show reversal of the described symptoms.