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European Journal of Pediatrics
Published in: European Journal of Pediatrics 5/2021

01-05-2021 | Infliximab | Original Article

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

Authors: Nahed Abdel-Haq, Basim I. Asmar, Maria P. Deza Leon, Eric J. McGrath, Harbir S. Arora, Katherine Cashen, Bradley Tilford, Ahmad Charaf Eddine, Usha Sethuraman, Jocelyn Y. Ang

Published in: European Journal of Pediatrics | Issue 5/2021

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Abstract

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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Metadata
Title
SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment
Authors
Nahed Abdel-Haq
Basim I. Asmar
Maria P. Deza Leon
Eric J. McGrath
Harbir S. Arora
Katherine Cashen
Bradley Tilford
Ahmad Charaf Eddine
Usha Sethuraman
Jocelyn Y. Ang
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 5/2021
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-021-03935-1

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