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. 2021 Apr 20;58(8):718–722. doi: 10.1007/s13312-021-2277-4

Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone

Sheeja Sugunan 1,✉, S Bindusha 1, S Geetha 1, H R Niyas 1, A Santhosh Kumar 1
PMCID: PMC8384095  PMID: 33876782

Abstract

Objective

To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and/or intravenous immunoglobulin (IVIG).

Method

This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks.

Results

Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5–9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group.

Conclusion

In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.

Keywords: Coronary artery, COVID-19, IVIG, Kawasaki disease

Acknowledgements

Dr S Lakshmi, HOD Pediatric Cardiology, Dr S Bindu, Unit Chiefs, Dr AS Ajith Krishnan, Dr VH Sankar, Dr VK Devakumar and Dr Leela Kumari, SAT, Government Medical College Thiruvananthapuram, who were involved in patient care. Dr K Sarada Devi, HOD, Department of Microbiology, Government Medical College Thiruvananthapuram and Dr Kavitha Raja, Professor, Department of Microbiology, SCTIMST for their support and guidance.

Footnotes

Ethics clearance

Human ethics committee, Medical College, Thiruvnanthapuram; No. 01/32/2021/MCT, dated Jan 15, 2021.

Contributors

SS: conceptualized and designed the study, analyzed data and participated in manuscript writing. BS: statistical analysis and interpretation of data, Critical revision of manuscript for intellectual content, GS: Statistical analysis, drafting of manuscript, Critical revision of manuscript for intellectual content; NHR: acquisition, analysis and interpretation of data, drafting of manuscript; SKA: supervised the study and contributed to the critical revision of manuscript for intellectual content. All authors approve the final version of manuscript, and are accountable for all aspects related to the study.

Funding

None

Competing interest

None stated.

References

  • 1.Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study. Lancet. 2020;395:1771–8. doi: 10.1016/S0140-6736(20)31103-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Jones VG, Mills M, Suarez D, et al. COVID-19 and Kawasaki disease: Novel virus and novel case. Hosp Pediatr. 2020;10:537–40. doi: 10.1542/hpeds.2020-0123. [DOI] [PubMed] [Google Scholar]
  • 3.Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20:e276–88. doi: 10.1016/S1473-3099(20)30651-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Abrams JY, Godfred-Cato SE, Oster ME, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome Coronavirus 2: A systematic review. J Pediatr. 2020;226:45–54.e1. doi: 10.1016/j.jpeds.2020.08.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) [Internet]. 2020. Accessed February 3, 2021. Available from: https://www.cdc.gov/mis-c/hcp/
  • 6.Health C for D and R. EUA Authorized Serology Test Performance. FDA [Internet]. Accessed February 26, 2021. Available from: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance
  • 7.Government of Kerala. Guidelines-Post-COVID-Clinics. pdf [Internet]. Accessed February 1, 2021. Available from: https://dhs.kerala.gov.in/wp-content/uploads/2020/10/
  • 8.McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017;135:e927. doi: 10.1161/CIR.0000000000000484. [DOI] [PubMed] [Google Scholar]
  • 9.Bhat CS, Gupta L, Balasubramanian S, et al. Hyperinflammatory syndrome in children associated with COVID-19: Need for awareness. Indian Pediatr. 2020;57:929–35. doi: 10.1007/s13312-020-1997-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Rowley AH, Shulman ST. The epidemiology and pathogenesis of Kawasaki disease. Front Pediatr [Internet]. 2018. Accessed December 7, 2020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298241/ [DOI] [PMC free article] [PubMed]
  • 11.Meena J, Yadav J, Saini L, et al. Clinical features and outcome of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Indian Pediatr. 2020;57:820–6. doi: 10.1007/s13312-020-1961-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Davies P, Evans C, Kanthimathinathan HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: A multicentre observational study. Lancet Child Adolesc Health. 2020;4:669–77. doi: 10.1016/S2352-4642(20)30215-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in US. Children and adolescents. N Engl J Med. 2020;383:334–46. doi: 10.1056/NEJMoa2021680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Godfred-Cato S, Bryant B, Leung J, et al. COVID-19-associated multisystem inflammatory syndrome in children — United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1074–80. doi: 10.15585/mmwr.mm6932e2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Kumar J, Meena J, Yadav A, Yadav J. Radiological findings of COVID-19 in children: A systematic review and meta-analysis. J Trop Pediat. 2020:fmaa045. [DOI] [PMC free article] [PubMed]
  • 16.Dhanalakshmi K, Venkatraman A, Balasubramanian S, et al. Epidemiological and clinical profile of pediatric inflammatory multisystem syndrome — temporally associated with SARS-CoV-2 (PIMS-TS) in Indian children. Indian Pediatr. 2020;57:1010–14. doi: 10.1007/s13312-020-2025-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Jain S, Sen S, Lakshmi venkateshiah S, et al. Multisystem inflammatory syndrome in children with COVID-19 in Mumbai, India. Indian Pediatr. 2020;57:1015–9. doi: 10.1007/s13312-020-2026-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children. JAMA. 2021;325:855–64. doi: 10.1001/jama.2021.0694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Harwood R, Allin B, Jones CE, et al. A National Consensus Management Pathway for Paediatric Inflammatory Multisystem Syndrome Temporally Associated With COVID-19 (PIMS-TS): Results of a national Delphi process. Lancet Child Adolesc Health. 2021;5:133–41. doi: 10.1016/S2352-4642(20)30304-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174:868–73. doi: 10.1001/jamapediatrics.2020.1948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Nakra NA, Blumberg DA, Herrera-Guerra A, et al. Multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: Review of clinical presentation, hypothetical pathogenesis, and proposed management. Children (Basel) 2020;7:E69. doi: 10.3390/children7070069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607–8. doi: 10.1016/S0140-6736(20)31094-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.McCrindle Brian W, Rowley Anne H, Newburger Jane W, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation. 2017;135:e927–99. doi: 10.1161/CIR.0000000000000484. [DOI] [PubMed] [Google Scholar]
  • 24.Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the Covid-19 pandemic in Paris, France: Prospective observational study. BMJ. 2020;369:m2094. doi: 10.1136/bmj.m2094. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Dufort EM, Koumans EH, Chow E J, New York State and Centre for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team et al. Multisystem inflammatory syndrome in children in New York state. N Engl J Med. 2020;383:347–58. doi: 10.1056/NEJMoa2021756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Accessed August 27, 2020. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19

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