Clinical profile of SARS-CoV-2 infection-associated pediatric Multisystem Inflammatory Syndrome (MIS-C): A case series from Western Maharashtra

Background and Objectives: Multisystem inflammatory syndrome (MIS-C) is a SARS-COV-2 infection-associated dreaded clinical sequelae in pediatric patients. Its epidemiology is complex and differs from severe acute COVID-19 infection in children. The present case-series report describes the various clinical features, laboratory markers, and interventions among 222 pediatric patients from one of the states in India with the highest prevalence of COVID-19 infection. Methods: An observational study was conducted at one of the tertiary healthcare institutes in the western region of Maharashtra state of India. Twenty-two children were hospitalized with diagnosed MIS-C, aged from 2 months to 18 years, from January to June 2021. Demographic and clinical characteristics and diagnostic and treatment parameters were collected from each subject. Statistical Package for Social Sciences version 21 software was used as a data analysis tool. Results: Clinical assessment revealed high-grade fever, non-purulent conjunctivitis, and abdominal complaints, which were the leading presentations of MIS-C. In inflammatory markers, serum IL-6 levels and D-dimer levels took a longer duration for normalization in the severe MIS-C group. Almost half of the mild-moderate MIS-C patients were managed with only systemic corticosteroids. All remaining patients recovered with the dual therapy of intravenous immunoglobulins (2 g/kg) and systemic corticosteroids with an improved clinical and biological response. Conclusions: The present clinical case-series report concluded that almost all MIS-C cases have a favorable prognosis with dual therapy of corticosteroids and immunoglobulins. With the principle of early diagnosis and prompt treatment, it is possible to manage patients without any critical support. However, long-term follow-up studies of these cases are warranted to validate the clinical approach. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

Severe Agitation as an Unusual Presentation of Multisystem Inflammatory Syndrome in Children.

Multisystem inflammatory syndrome in children (MIS-C) is a rare hyperinflammatory syndrome that mainly affects children after a primary infection with coronavirus disease 2019 (COVID-19), with the possibility of severe and lethal complications. We report a case of a unique presentation of MIS-C in a four-year-old boy who presented with severe agitation, muscle spasms, and two days of fever. Other findings consistent with MIS-C were revealed later, and he was managed with intravenous immunoglobulin (IVIG) and steroids. He showed a dramatic response of improvement and was discharged. This case report aimed to raise health professionals' awareness about the atypical presentations of MIS-C and the importance of early diagnosis, treatment, and follow-up MIS-C cases to avoid complications affecting children's lives.

Supraventricular Tachycardia: An Atypical Presentation of Thyroid Storm.

Thyroid storm (or thyrotoxic crisis) is commonly defined as a life-threatening condition caused by the exaggeration of the clinical manifestations of thyrotoxicosis. Supraventricular tachycardia (SVT) is an atypical precipitating symptom of thyrotoxicosis that clinicians should be aware of. An empirically derived scoring system known as the Burch-Wartofsky Point Scale (BWPS) has been used by clinicians since the early 1990s. The BWPS considers an array of precipitating factors and the severity of symptoms of multiple organ decompensation. In recent years, there has been an increasing correlation between SARS-CoV-2 and thyroid pathologies. We present a case of an unresponsive elderly male with a recent coronavirus disease 2019 (COVID-19) infection presenting with SVT and a BWPS score of 45, highly indicative of a thyroid storm.