PMID- 33452570 OWN - NLM STAT- MEDLINE DCOM- 20210427 LR - 20221207 IS - 1432-1076 (Electronic) IS - 0340-6199 (Print) IS - 0340-6199 (Linking) VI - 180 IP - 5 DP - 2021 May TI - SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment. PG - 1581-1591 LID - 10.1007/s00431-021-03935-1 [doi] AB - 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. FAU - Abdel-Haq, Nahed AU - Abdel-Haq N AUID- ORCID: 0000-0001-6957-4756 AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. nabdel@dmc.org. AD - Wayne State University, Detroit, MI, USA. nabdel@dmc.org. AD - Central Michigan University, Mount Pleasant, MI, USA. nabdel@dmc.org. FAU - Asmar, Basim I AU - Asmar BI AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Wayne State University, Detroit, MI, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. FAU - Deza Leon, Maria P AU - Deza Leon MP AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. FAU - McGrath, Eric J AU - McGrath EJ AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Wayne State University, Detroit, MI, USA. FAU - Arora, Harbir S AU - Arora HS AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Wayne State University, Detroit, MI, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. FAU - Cashen, Katherine AU - Cashen K AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Wayne State University, Detroit, MI, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. FAU - Tilford, Bradley AU - Tilford B AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. FAU - Charaf Eddine, Ahmad AU - Charaf Eddine A AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. FAU - Sethuraman, Usha AU - Sethuraman U AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Wayne State University, Detroit, MI, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. FAU - Ang, Jocelyn Y AU - Ang JY AD - Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. AD - Wayne State University, Detroit, MI, USA. AD - Central Michigan University, Mount Pleasant, MI, USA. LA - eng PT - Journal Article DEP - 20210116 PL - Germany TA - Eur J Pediatr JT - European journal of pediatrics JID - 7603873 RN - B72HH48FLU (Infliximab) RN - pediatric multisystem inflammatory disease, COVID-19 related SB - IM MH - Adolescent MH - COVID-19/diagnosis MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Infant MH - Infliximab/*therapeutic use MH - Male MH - Mucocutaneous Lymph Node Syndrome/diagnosis/drug therapy MH - Systemic Inflammatory Response Syndrome/diagnosis/*drug therapy MH - *COVID-19 Drug Treatment PMC - PMC7810600 OTO - NOTNLM OT - COVID-19 OT - IVIG OT - Infliximab OT - Kawasaki disease OT - MIS-C COIS- The authors declare that they have no conflict of interest. EDAT- 2021/01/17 06:00 MHDA- 2021/04/28 06:00 PMCR- 2021/01/16 CRDT- 2021/01/16 05:40 PHST- 2020/09/19 00:00 [received] PHST- 2021/01/06 00:00 [accepted] PHST- 2020/12/08 00:00 [revised] PHST- 2021/01/17 06:00 [pubmed] PHST- 2021/04/28 06:00 [medline] PHST- 2021/01/16 05:40 [entrez] PHST- 2021/01/16 00:00 [pmc-release] AID - 10.1007/s00431-021-03935-1 [pii] AID - 3935 [pii] AID - 10.1007/s00431-021-03935-1 [doi] PST - ppublish SO - Eur J Pediatr. 2021 May;180(5):1581-1591. doi: 10.1007/s00431-021-03935-1. Epub 2021 Jan 16.