Table 3.
Summary of 13 children with MIS-C who required intensive care and second-line therapy (infliximab/a second IVIG dose) following first-line therapy with IVIG
| Age/sex/ethnicity | KD-like features | COVID-19 tests | ECG findings | ECHO findings * | Anti-inflammatory treatment | Supportive care | Outcome/follow-up |
|---|---|---|---|---|---|---|---|
|
#1 17 year Male AA |
No | COVID-19 PCR-positive; COVID-19 IgG-positive | ECG: sinus rhythm with 1st-degree AV block, RBBB | SF 12.6%, EF 26.9% Z scores: LMCA 4.2, LAD 2.77, RCA 1.87 | IVIG on D#1 Infliximab on D#4 D#8 Pulse methylprednisolone 1 g IV daily × 3 | Mechanical ventilation (6 days) ECMO (4 days) Vasopressors (6 days) | Improved (LOS 22 days, PICU 18 days) ECHO D#77: NL anatomy and function. Z scores: LMCA 2.1, LAD 0.08, RCA 0.04 |
|
#2 14 years Female AA |
No | COVID-19 PCR-negative COVID-19 IgG-positive | ECG: accelerated junctional rhythm, prolonged QTc | SF 23.3%, EF 46.4% Z scores: LMCA 0.58, LAD − 0.41, RCA − 0.35 | IVIG on D#1 Infliximab on D#2 | Mechanical ventilation (4 days) Vasopressors (4 days) | Improved (LOS 14 days, PICU 7 days) ECHO D#26: NL |
| #3 3 months Female AA | Yes (classic) | COVID-19 PCR-positive COVID-19 IgG-NA | SF 36.1%, EF 68.3% Z scores: LMCA 2.2, LAD 3.72, RCA 0.39 | IVIG on D#1 Infliximab on D#3 | Improved (LOS 7 days, PICU 3 days) ECHO D#59: NL LV function. NL coronary arteries | ||
|
#4 3 years Male AA |
Yes (classic) | COVID-19 PCR-negative COVID-19 IgG-positive | SF 21%, EF 43.2% Z scores: LMCA 5.02, LAD 0.97, RCA − 0.88 | IVIG on D#1 IVIG D#4 Infliximab on D#6 | Vasopressors (2 days) | Improved (LOS 8 days, PICU 5 days) D#80 ECHO: NL function. NL coronary arteries | |
|
#5 7 years Male South Asian |
Yes (Incomplete) | COVID-19 PCR-negative COVID-19 IgG-negative COVID-19-exposed | ECG: PVCs and trigeminy | SF 36.4%, EF 67.2% Z scores: LMCA 0.32, LAD 0.66, RCA − 0.17 | IVIG on D#1 Infliximab on D#3 | Improved (LOS 7 days, PICU 3 days) ECHO D#65: NL | |
|
#6 8 years Female ME |
Yes (classic) | COVID-19 PCR-positive COVID-19 IG-positive | SF 30%, EF 58.2% Z scores: LMCA − 0.47, LAD − 0.43, RCA 0.59 | IVIG on D#1 Infliximab on D#3 | Vasopressors (4 days) Oxygen supplement (4 days) | Improved (LOS 10 days, PICU 4 days) ECHO D#73: NL | |
|
#7 6 years Male AA |
No | COVID-19 PCR-negative COVID-19 IgG-positive | ECG: accelerated junctional rhythm, borderline prolonged QTc | SF 26%, EF 51.7% Z scores: LMCA − 0.27, LAD 0.69, RCA − 0.22 | IVIG on D#1 Infliximab on D#2 | Vasopressors (2 days) Oxygen supplement (2 days) | Improved (LOS 5 days, PICU 2 days) ECHO D#24: NL EKG D#24: NL |
|
#8 9 years Female AA |
No | COVID-19 PCR-negative COVID-19 IgG-positive | SF 17.2%, EF 36.5% Z scores: LMCA − 0.47, LAD − 0.43, RCA 0.59 | IVIG on D#1 Infliximab on D#2 | Vasopressors (3 days) Oxygen supplement (1 days) | Improved (LOS 5 days, PICU 3 days) ECH0 D#73: NL | |
|
#9 11 years Male AA |
No | COVID-19 PCR-negative COVID-19 IgG-positive | SF 25.7%, EF 50.8% Z scores: LMCA 0.87, LAD 1.48, RCA 1.69 | IVIG on D#1 Infliximab on D#3 | Mechanical ventilation (5 days) Vasopressors (4 days) | Improved (LOS 9 days, PICU 7 days) ECHO D#67: NL | |
|
#10 15 years Male AA |
Yes (incomplete) | COVID-19 PCR-positive COVID-19 IgG-positive | ECG: accelerated junctional rhythm | SF 8.1%, EF 17.5% Z scores: LMCA 0.32, LAD 1.17, RCA 3.18 | IVIG on D#1 Infliximab on D#2 | Mechanical ventilation (5 days) Vasopressors (6 days) | Improved (LOS 8 days, PICU 8 days) ECHO D#164: EF 58.3%. Z score: LMCA 1.21, RCA 1.51 |
|
#11 10 years Female AA |
No | COVID-19 PCR-neagtive COVID-19 IgG-positive | SF 24.1%, EF 48.2% Z scores: LMCA 0.32, LAD 0.63, RCA 0.51 | IVIG on D#1 Infliximab on D#2 | Vasopressors (6 days) Oxygen supplement (6 days) | Improved (LOS 10 days, PICU 7 days) ECHO D#50: NL | |
|
#12 7 years Female AA |
No | COVID-19 PCR-negative COVID-19 IgG-positive | SF 38.8%, EF 69.9% Z scores: LMCA − 0.46, LAD − 0.13, RCA − 0.14 | IVIG on D#1 Infliximab on D#3 | Improved (LOS 7 days, PICU 3 days) | ||
|
#13 7 years Male AA |
Yes (classic) | COVID-19 PCR-negative COVID-19 IgG-positive | SF 25.9%, EF 51.1% Z scores: LMCA 2.37, LAD 0.65, RCA 0.79 | IVIG on D#1 IVIG on D#3 | Mechanical ventilation (5 days) Vasopressors (4 days) | Improved (LOS 13 days, PICU 8 days) D#45 ECHO: EF 61.6%. Z scores: LMCA 1.4. LAD − 1.7. RCA − 2.7. |
MIS-C patients with dilated coronary arteries are numbered in bold IVIG intravenous immunoglobulins, D# day of PICU admission/IVIG administration, ECHO echocardiogram, SF shortening fraction, EF ejection fraction, LMCA left main coronary artery, LAD left anterior descending artery, RCA right coronary artery, ECMO extracorporeal membrane oxygenation, NL normal, LV left ventricle, RBBB right bundle branch block, PE pericardial effusion, NA not available, ECG electrocardiogram, PVC premature ventricular contraction, LOS length of hospital stay, PICU pediatric intensive care unit, AA African American, ME Middle Eastern *Significant echocardiographic findings during hospitalization; no coronary aneurysms were detected