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 (r_s=0.85), CRP and IL-6 (r_s=0.70), and medium correlation between ferritin and procalcitonin (r_s=0.53), ferritin and IL-6 (r_s=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.