Immunomodulatory Therapy in Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 in Children

ABSTRACT

BACKGROUND AND AIM: The clinical spectrum and management of Multi-system Inflammatory Syndrome in Children (MIS-C) is evolving with each wave of COVID-19 and emerging literature. This study aims to describe the clinico-pathological spectrum and immunomodulatory management of MIS-C in a tertiary care hospital in south India. METHOD(S) This prospective observational study included children satisfying CDC MIS-C criteria admitted from September 2019 to January 2022. We studied the characteristics of patients receiving immunomodulatory therapy with respect to need for inotropic support, duration of stay, mortality, escalation of immunomodulation, time to defervescence and persistence of coronary abnormalities at 2 weeks. RESULT(S) 102 children were included with median (IQR) age of 5.5 (3.2-8.5) years with male female ratio of 1.84. Gastrointestinal symptoms were seen in 85 (84%), cardiac manifestations in 48 (47%) and coronary artery dilatation was seen in 33 (32%). Methylprednisolone and intravenous immunoglobulin were used as first line therapy in 31 (30.4%), and 25 (24.5%) patients, respectively. 46 (45.1%) children received both IVIG and IV Methylprednisolone. 30 (29%) presented with shock and 28 (27%) required inotropic support. Defervescence at 48hrs was observed in 30 (96%) in steroids alone group, 18 (72%) in IVIG group and 26 (57%) in IVIG+steroid group. 4 needed additional immunomodulatory therapy with Anakinra (table 1). None of them required 2nd dose of IVIG. There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 9 children. CONCLUSION(S) Immunomodulator therapy was based on severity at presentation and all combinations of therapy were effective.