COVID 19 Related Multisystem Inflammatory Syndrome in Children Admitted to PICU in Ain Shams University Hospitals

Abstract

evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology (post-infectious complication). Our cases of MIS-C have features of shock, with cardiac involvement, most of them have gastrointestinal symptoms, rash, conjunctivitis, and significantly elevated markers of inflammation, with positive laboratory test results for SARS-CoV-2 e.g. RT-PCR or serology (at least one of them is positive). Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), or interleukin-1 receptor antagonist (anakinra) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy.