Case Series of Severe Multisystem Inflammatory Syndrome in Children (Mis-C) in a Tunisian Picu (2020-2021)

ABSTRACT

BACKGROUND AND AIM: Multisystem inflammatory syndrome in children (MIS-C) is a new serious emerging disease related to previous exposure to coronavirus infection disease (COVID-19). AIM: To describe the clinical features, laboratory findings, therapies, and outcomes of children with MIS-C in a Tunisian PICU. METHOD(S) Prospective study conducted between 01 November and 30 December 2021. Patients aged less than 15 years, admitted to our PICU, and met the criteria for MIS-C according to the WHO definition case, were included. Demographic and clinical data, laboratory test results, echocardiographic findings, treatment, and outcomes were collected during hospitalization. RESULT(S) The median age was 9 years (IQR 5-10). Obesity was noted in 1 patient. Ten patients were boys. Median delay between symptom and PICU admission was 6days (IQR5-7). Fever and gastrointestinal symptoms were reported in all cases. Five patients had marked abdominal pain and were examined by the surgeon for a possible appendicitis. Cardiac dysfunction was reported in 13 cases with a median LVEF 42% (IQR 33-50). Two patients had a vasoplegic shock and needed norepinephrine. Median CRP was 281mg/l (166-347). Median lymphocyte count was 880cells /mm3(520-1270). Median D-Dimers was 4631 ng/ ml (1582-8672). Median troponin was 339ng/L (IQR 36 879). Median pro BNP was 9199pg/ml (2825-25000). All patients had positive SARS-COV-2 serology. Only 4 patients required mechanical ventilation. All patients received inotropes, immunoglobulins, methyl prednisolone and a low dose of aspirin. One patient died. CONCLUSION(S) We report herein clinical features, management, and outcomes of critically ill children with MIS-C to highlight the severity of clinical presentation with a good prognosis.