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SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment.

Publication ,  Journal Article
Abdel-Haq, N; Asmar, BI; Deza Leon, MP; McGrath, EJ; Arora, HS; Cashen, K; Tilford, B; Charaf Eddine, A; Sethuraman, U; Ang, JY
Published in: Eur J Pediatr
May 2021

This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children's Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)-like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered.Conclusion: MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) manifestations include fever, gastrointestinal symptoms, shock, and occasional features of Kawasaki disease (KD). • Treatment includes immunomodulatory agents, most commonly IVIG and corticosteroids. What is New: • Spectrum of MIS-C varies from mild to severe inflammation and coronary artery dilatation occurred in 5/22 (23%) critically ill patients. • IVIG and infliximab therapy were associated with a favorable outcome including resolution of coronary dilatation; only 2/33 received corticosteroids.

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Published In

Eur J Pediatr

DOI

EISSN

1432-1076

Publication Date

May 2021

Volume

180

Issue

5

Start / End Page

1581 / 1591

Location

Germany

Related Subject Headings

  • Systemic Inflammatory Response Syndrome
  • Pediatrics
  • Mucocutaneous Lymph Node Syndrome
  • Male
  • Infliximab
  • Infant
  • Humans
  • Female
  • Child, Preschool
  • Child
 

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Abdel-Haq, N., Asmar, B. I., Deza Leon, M. P., McGrath, E. J., Arora, H. S., Cashen, K., … Ang, J. Y. (2021). SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment. Eur J Pediatr, 180(5), 1581–1591. https://doi.org/10.1007/s00431-021-03935-1
Abdel-Haq, Nahed, Basim I. Asmar, Maria P. Deza Leon, Eric J. McGrath, Harbir S. Arora, Katherine Cashen, Bradley Tilford, Ahmad Charaf Eddine, Usha Sethuraman, and Jocelyn Y. Ang. “SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment.Eur J Pediatr 180, no. 5 (May 2021): 1581–91. https://doi.org/10.1007/s00431-021-03935-1.
Abdel-Haq N, Asmar BI, Deza Leon MP, McGrath EJ, Arora HS, Cashen K, et al. SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment. Eur J Pediatr. 2021 May;180(5):1581–91.
Abdel-Haq, Nahed, et al. “SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment.Eur J Pediatr, vol. 180, no. 5, May 2021, pp. 1581–91. Pubmed, doi:10.1007/s00431-021-03935-1.
Abdel-Haq N, Asmar BI, Deza Leon MP, McGrath EJ, Arora HS, Cashen K, Tilford B, Charaf Eddine A, Sethuraman U, Ang JY. SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment. Eur J Pediatr. 2021 May;180(5):1581–1591.
Journal cover image

Published In

Eur J Pediatr

DOI

EISSN

1432-1076

Publication Date

May 2021

Volume

180

Issue

5

Start / End Page

1581 / 1591

Location

Germany

Related Subject Headings

  • Systemic Inflammatory Response Syndrome
  • Pediatrics
  • Mucocutaneous Lymph Node Syndrome
  • Male
  • Infliximab
  • Infant
  • Humans
  • Female
  • Child, Preschool
  • Child