Table 2.
Patients exhibiting multisystem inflammatory syndrome.
| Patient | Characteristics | Clinical presentation | Support modality | Treatment | Lab results | Microbiology status | Outcome (PICU LOS; status) |
|---|---|---|---|---|---|---|---|
| 1 | Male, 14 years, Afro-Caribbean. | Fever: 4 d >40°C. Diarrhea; abdominal pain; headache | MV, KRT, VA-ECMO | Dopamine, noradrenaline, argipressin, adrenaline, milrinone, hydrocortisone, IVIG, ceftriaxone, lindamycin | Ferritin 4,220 μg/L; D-dimers 13·4 mg/L; troponin 675 ng/L; proBNP >35,000; CRP 556 mg/L; procalcitonin>100 μg/L; albumin 20 g/L; platelets 123 × 109 | SARS-CoV-2 positive (post-mortem) | 6 days; deceased due to right MCA and ACA ischemic infarction. |
| 2 | Male, 8 years, Afro-Caribbean. | Fever: 5 d >39°C. Diarrhea; abdominal pain; conjunctivitis; rash | MV | Noradrenaline, adrenaline, IVIG, infliximab, methylprednisolone, ceftriaxone, lindamycin | Ferritin 277 μg/L; D-dimers 4·8 mg/L; troponin 25 ng/L; CRP 295 mg/L; procalcitonin 8·4 μg/L; albumin 18 g/L; Platelets 61 × 109 | SARS-CoV-2 negative (likely exposure from mother) | 4 days; alive |
| 3 | Male, 4 years, Middle Eastern. | Fever: 4 d >39°C. Diarrhea; vomiting; abdominal pain; conjunctivitis | MV | Noradrenaline, adrenaline, IVIG ceftriaxone, clindamycin | Ferritin 574 μg/L; D-dimers 11·7 mg/L; troponin 45 ng/L; CRP 322 mg/L; procalcitonin 10·3 μg/L; albumin 22 g/L; Platelets 103 × 109 | Adenovirus positive; HERV positive | 4 days; alive |
| 4 | Female, 13 years, Afro-Caribbean. | Fever: 5 d >39°C. Diarrhea; abdominal pain; conjunctivitis | HFNC | Noradrenaline, milrinone, IVIG,ceftriaxone, lindamycin | Ferritin 631 μg/L; D-dimers 3·4 mg/L; troponin 250 ng/L; proBNP 13,427 ng/L; CRP 307 mg/L; procalcitonin 12·1 μg/L; albumin 21 g/L; Platelets 146 × 109 | SARS-CoV-2 negative | 5 days; alive |
| 5 | Male, 6 years, Asian. | Fever: 4 d >39°C. Odynophagia; conjunctivitis; rash | NIV | Milrinone, IVIG, methylprednisolone, aspirin, ceftriaxone | Ferritin 550 μg/L; D-dimers 11·1 mg/L; troponin 47 ng/L; NT-proBNP 7,004 ng/L; CRP 183 mg/L; albumin 24 g/L; platelets 165 × 109 | SARS-CoV-2 positive (likely exposure from father) | 4 days; alive |
| 6 | Female, 6 years, Afro-Caribbean. | Fever: 5 d >39°C. Diarrhea & vomiting (3 d); myalgia; conjunctivitis | NIV | Dopamine, noradrenaline, milrinone, IVIG, methylprednisolone, aspirin, ceftriaxone, clindamycin | Ferritin 1,023 μg/L; D-dimers 9·9 mg/L; troponin 45 ng/L; NT-proBNP 9,376 ng/L; CRP mg/L 169; procalcitonin 11·6 μg/L; albumin 25 g/L; platelets 158 | SARS-CoV-2 negative (likely exposure from grandfather) | 3 days; alive |
| 7 | Male, 12 years, Afro-Caribbean. | Fever: 4 d >39°C. Diarrhea & vomiting (2 d); abdominal pain; headache; rash; odynophagia | MV | Noradrenaline, adrenaline, milrinone, IVIG, methylprednisolone, heparin, ceftriaxone, clindamycin, metronidazole | Ferritin 958 μg/L; D-dimer 24·5 mg/L; troponin 813 ng/L; NT-proBNP >35 000 ng/L; CRP 251 mg/L; procalcitonin 71·5 μg/L; Albumin 24 g/L; Platelets 273 × 109 | SARS-CoV-2 negative | 4 days; alive |
| 8 | Female, 8 years, Afro-Caribbean. | Fever: 4 d >39°C. Diarrhea & vomiting (2 d); abdominal pain; odynophagia | MV | Dopamine, noradrenaline, milrinone, IVIG, aspirin, ceftriaxone, clindamycin | Ferritin 460 μg/L; D-dimers 4·3 mg/L; troponin 120 ng/L; CRP 347 mg/L; procalcitonin 7·42 μg/L; albumin 22 g/L; Platelets 296 × 109 | SARS-CoV-2 negative (likely exposure from parent) | 7 days; alive |
Adapted from Riphagen et al. (23).
ACA, anterior cerebral artery; CRP, C-reactive protein; HERV, human endogenous retrovirus; HFNC, high-flow nasal canula; HR, heart rate; IVIG, human intravenous immunoglobulin; LOS, length of stay; MCA, middle cerebral artery; MV, mechanical ventilation via endotracheal tube; NIV, non-invasive ventilation; PICU, pediatric intensive care unit; KRT, kidney replacement therapy; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; VA-ECMO, veno-arterial extracorporeal membrane oxygenation.