Our experience with pediatric inflammatory multisystem syndrome associated with COVID-19 (PIMS-TS)

Czech version

Authors: M. Igaz ¹; M. Kostková ¹; T. Bělohlávek ²; F. Olekšák ¹; M. Jeseňák ¹; Peter Bánovčin ¹
Authors‘ workplace: Klinika detí a dorastu, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin, Slovensko ¹; Klinika detskej anesteziológie a intenzívnej medicíny, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin, Slovensko ²
Published in: Čes-slov Pediat 2021; 76 (1): 10-17.
Category:

Overview

COVID-19 is usually asymptomatic or mild in the pediatric population. This is mainly due to the absence of other diseases that could worsen the condition with their clinical manifestation, but also, for example, the influence of androgens on ACE2 receptor expression. The number of hospitalizations in pediatric patients with acute COVID-19 has been low since the onset of the pandemic. However, in April 2020, the World Health Organization drew attention to the increasing number of hospitalizations of pediatric patients, especially in intensive care units with clinical symptomatology similar to sepsis, Kawasaki syndrome, toxic shock syndrome or activated macrophage syndrome. The condition was associated with acute or past SARS-CoV-2 infection.

The authors present two case reports of pediatric patients with fully expressed clinical symptomatology of pediatric inflammatory multisystem syndrome. The clinical picture was dominated by febris remittens, cardiac insufficiency, non-purulent conjunctivitis, palmar and plantar erythema, rash. High inflammatory activity and positive antibodies against SARS-CoV-2 in the IgG class were present in the laboratory parameters. They were treated with intravenous immunoglobulins, systemic corticoids, anticoagulants and antiplatelet drugs. Vasoactive and inotropic support and in one case artificial lung ventilation were needed. An adequate effect of immunosuppressive and subsequent immunomodulatory treatment was observed in both patients.

Keywords:

COVID-19, PIMS-TS, pediatric multisystem inflammatory syndrome temporaly associated to COVID-19

Sources

1. Han MS, Choi EH, Chang SH, et al. Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea. JAMA Pediatr 2021; 175 (1):73–80.

2. Kim L, Whitaker M, O’Halloran A, et al. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 – COVID-NET, 14 States, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (32): 1081–1088.

3. WHO Scientific Brief. Multisystem inflammatory syndrome in children and adolescents with COVID-19. 2020; 1–3. https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.

4. Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 (10237): 1607–1608.

5. Oleksak F, Jesenak M, Kapustova L, et al. Pediatrický zápalový multisystémový syndróm asociovaný s COVID-19. Alergie 2020; (3): 181–185.

6. Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395 (10239): 1771–1778.

7. Cabrero-Hernández M, García-Salido A, Leoz-Gordillo I, et al. Severe SARS-CoV-2 infection in children with suspected acute abdomen: a case series from a tertiary hospital in Spain. Pediatr Infect Dis J 2020; 39 (8): 195–198.

8. Rauf A, Vijayan A, John ST, et al. Multisystem inflammatory syndrome with features of atypical Kawasaki disease during COVID-19 pandemic. Indian J Pediatr 2020; 87: 745–747.

9. Kaushik S, Aydin SI, Derespina KR, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection: a multi-institutional study from New York City. J Pediatr 2020; 224: 24–29.

10. Lawrensia S, Henrina J, Wijaya E, et al. Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: a New Challenge amid the Pandemic. SN Compr Clin Med 2020; 2: 2077–2085.

11. Belhadjer Z, Bonnet D. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Running title: Belhadjer et al. Pediatric acute heart failure and SARS-CoV-2 infection Covid-19. Circulation 2020; 33. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048360.

12. Chiotos K, Bassiri H, Behrens E, et al. Multisystem Inflammatory Syndrome in Children during the COVID-19 pandemic: a case series. J Pediatric Infect Dis Soc 2020; 9 (3): 393–398.

13. Davies P, Evans C, Kanthimathinathan HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4 (9): 669–677.

14. The Royal College of Paediatrics and Child Health. West Midlands Guidance for the early recognition, investigation and management of the Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARSCoV2 pandemic. 2020. https://kids.bwc.nhs.uk/wp-content/uploads/2020/05/PIMS-TS-Guidance-05-05-20-v1.pdf.

15. European Centre for Disease Prevention and Control. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children. ECDC 2020; 1–18. https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf.

16. Goldenberg NA, Sochet A, Albisetti M. Consensus‐based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalised for COVID-19 – related illness. J Thromb Haemost 2020; 18: 3099–3105.

17. Vičar J, Balatka V, Šácha O, et al. Pandemie COVID-19 z pohledu dětské kliniky krajské nemocnice. Čes-slov Pediat 2020; 75 (5): 267–270.