Hepato-biliary Manifestations of Multisystem Inflammatory Syndrome in Children: Single Centre Experience

ABSTRACT

Background: Multisystem inflammatory syndrome in children (MIS-C) has been recognised as a rare and serious complication that involves multiple systems. Gastrointestinal (GI) symptoms like pain abdomen, vomiting, loose stools are common presenting features. Despite an abundance of ACE2 and TMPRSS2 cell receptors in intestine and biliary epithelium severe liver dysfunction is uncommon and very few studies have elaborated hepatic manifestations. Aims: To analyse spectrum of hepatic manifestations in MIS-C. Methods: We retrospectively reviewed the data of children diagnosed with MIS-C at our centre during first and second COVID wave (April 2020-May2021). 30 children were identified and recruited in the study. Their demographic, clinical and biochemical parameters were studied. Results: The mean age of presentation was 7 years. 76.6%(n=23) were male and 23.3%(n=7) were female. 90%(n=27) children had concomitant or isolated gastrointestinal complaints. 44.4% presented with abdominal pain (n=12), 33.3%(n=9) had loose stools, 18.5%(n=5) had vomiting. Only 1 child presented with blood in stool. All patients had positive COVID-19 IgG antibodies (mean titre- 40.1AU/ml). Mean C-reactive protein was 94.7mmHr. 50%(n=15) had deranged liver function tests. Both hyperbilirubinemia with raised liver enzymes were noted in 3(20%), both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevation in 8 (53.3%), isolated AST elevation in 4 (26.6%). International normalised ratio (INR) was normal in all. Abdominal imaging (n=8) was normal in 2(25%), two showed distal ileal diffuse mural thickening, two had cholecystitis and one had pancreatitis. 1 expired (3.3%) and 29(96.6%) were discharged successfully. Conclusion: GI manifestations are common and so is the hepatobiliary involvement. Hepatocellular injury leading to hepatitis pattern is common, but involvement of pancreatico-biliary system should also be ruled out. Prognosis is excellent without any residual damage to the liver clinically, biochemically, and radiologically.