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Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflammatory syndrome in children.
Lee, Pui Y; Day-Lewis, Megan; Henderson, Lauren A; Friedman, Kevin G; Lo, Jeffrey; Roberts, Jordan E; Lo, Mindy S; Platt, Craig D; Chou, Janet; Hoyt, Kacie J; Baker, Annette L; Banzon, Tina M; Chang, Margaret H; Cohen, Ezra; de Ferranti, Sarah D; Dionne, Audrey; Habiballah, Saddiq; Halyabar, Olha; Hausmann, Jonathan S; Hazen, Melissa M; Janssen, Erin; Meidan, Esra; Nelson, Ryan W; Nguyen, Alan A; Sundel, Robert P; Dedeoglu, Fatma; Nigrovic, Peter A; Newburger, Jane W; Son, Mary Beth F.
  • Lee PY; Division of Immunology and.
  • Day-Lewis M; Division of Immunology and.
  • Henderson LA; Division of Immunology and.
  • Friedman KG; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Lo J; Division of Immunology and.
  • Roberts JE; Division of Immunology and.
  • Lo MS; Division of Immunology and.
  • Platt CD; Division of Immunology and.
  • Chou J; Division of Immunology and.
  • Hoyt KJ; Division of Immunology and.
  • Baker AL; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Banzon TM; Division of Immunology and.
  • Chang MH; Division of Immunology and.
  • Cohen E; Division of Immunology and.
  • de Ferranti SD; Division of Pediatric Rheumatology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA.
  • Dionne A; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Habiballah S; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Halyabar O; Division of Immunology and.
  • Hausmann JS; Division of Immunology and.
  • Hazen MM; Division of Immunology and.
  • Janssen E; Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Meidan E; Division of Immunology and.
  • Nelson RW; Division of Immunology and.
  • Nguyen AA; Division of Immunology and.
  • Sundel RP; Division of Immunology and.
  • Dedeoglu F; Division of Immunology and.
  • Nigrovic PA; Division of Immunology and.
  • Newburger JW; Division of Immunology and.
  • Son MBF; Division of Immunology and.
J Clin Invest ; 130(11): 5942-5950, 2020 11 02.
Article in English | MEDLINE | ID: covidwho-670865
ABSTRACT
BACKGROUNDPediatric SARS-CoV-2 infection can be complicated by a dangerous hyperinflammatory condition termed multisystem inflammatory syndrome in children (MIS-C). The clinical and immunologic spectrum of MIS-C and its relationship to other inflammatory conditions of childhood have not been studied in detail.METHODSWe retrospectively studied confirmed cases of MIS-C at our institution from March to June 2020. The clinical characteristics, laboratory studies, and treatment response were collected. Data were compared with historic cohorts of Kawasaki disease (KD) and macrophage activation syndrome (MAS).RESULTSTwenty-eight patients fulfilled the case definition of MIS-C. Median age at presentation was 9 years (range 1 month to 17 years); 50% of patients had preexisting conditions. All patients had laboratory confirmation of SARS-CoV-2 infection. Seventeen patients (61%) required intensive care, including 7 patients (25%) who required inotrope support. Seven patients (25%) met criteria for complete or incomplete KD, and coronary abnormalities were found in 6 cases. Lymphopenia, thrombocytopenia, and elevation in inflammatory markers, D-dimer, B-type natriuretic peptide, IL-6, and IL-10 levels were common but not ubiquitous. Cytopenias distinguished MIS-C from KD and the degree of hyperferritinemia and pattern of cytokine production differed between MIS-C and MAS. Immunomodulatory therapy given to patients with MIS-C included intravenous immune globulin (IVIG) (71%), corticosteroids (61%), and anakinra (18%). Clinical and laboratory improvement were observed in all cases, including 6 cases that did not require immunomodulatory therapy. No mortality was recorded in this cohort.CONCLUSIONMIS-C encompasses a broad phenotypic spectrum with clinical and laboratory features distinct from KD and MAS.FUNDINGThis work was supported by the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases; the National Institute of Allergy and Infectious Diseases; Rheumatology Research Foundation Investigator Awards and Medical Education Award; Boston Children's Hospital Faculty Career Development Awards; the McCance Family Foundation; and the Samara Jan Turkel Center.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Immunoglobulins, Intravenous / Adrenal Cortex Hormones / Systemic Inflammatory Response Syndrome / Interleukin 1 Receptor Antagonist Protein / Immunomodulation / Betacoronavirus Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Topics: Variants Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Language: English Journal: J Clin Invest Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Immunoglobulins, Intravenous / Adrenal Cortex Hormones / Systemic Inflammatory Response Syndrome / Interleukin 1 Receptor Antagonist Protein / Immunomodulation / Betacoronavirus Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Topics: Variants Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Language: English Journal: J Clin Invest Year: 2020 Document Type: Article