Alkan Gulsum, Sert Ahmet, Oz Sadiye Kubra Tuter, Emiroglu Melike, Yılmaz Resul
Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Konya, Turkey.
Department of Pediatric Cardiology, Selcuk University Faculty of Medicine, Konya, Turkey.
Clin Rheumatol. 2021 Oct;40(10):4179-4189. doi: 10.1007/s10067-021-05754-z. Epub 2021 May 6.
Multisystem inflammatory syndrome in children (MIS-C) is a new clinical condition characterized by signs of inflammation and multiorgan dysfunction due to cytokine storm associated with SARS-CoV-2. The clinical spectrum of MIS-C ranges from mild to severe, and even to mortal multisystem involvement. To guide clinicians, we evaluated detailed demographic characteristics, clinical features, laboratory findings, and outcomes of MIS-C cases.
We performed a retrospective study of patients with MIS-C who were managed in the Department of Pediatric Infectious Disease in the Selcuk University Faculty of Medicine, Konya, Turkey. MIS-C patients were divided into three clinical severity groups (mild, moderate, and severe) and separated into three age groups (< 5 years, 5-10 years, > 10 years). We compared the characteristics of MIS-C cases according to the severity of the disease and by age groups.
Thirty-six children with MIS-C were evaluated (52.8% male, median age of 7.8 years). A clinical spectrum overlapping with Kawasaki disease (KD) was the most common presentation (69.4%) in all age groups. The most common clinical symptoms were fever (100%), mucocutaneous rash (69.4%), and gastrointestinal symptoms (66.6%). There was no statistically significant difference in echocardiographic abnormality between KD-like and the other clinical spectra (p > 0.05). All life-threatening rhythm disturbances were observed in severe cases. No patients died.
It is important to increase the awareness of physicians about the MIS-C disease, which can present with different combinations of different systemic findings, so that patients can be diagnosed and treated in a timely manner. Key Points • A single tertiary centre study shows that children with MIS-C can present with different clinic spectra other than Kawasaki diseases. • Electrocardiographic and echocardiographic evaluation is important in early diagnosis of children with MIS-C. • Pro-BNP can be used as a screening test in the emergency room for children with prolonged and unexplained fever for determine early cardiac involvement of MIS-C. • The lack of require biological agents and favourable outcomes in children with MIS-C may be related with administration of steroid therapy with IVIG in early stage of disease.
儿童多系统炎症综合征（MIS-C）是一种新的临床病症，其特征为与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关的细胞因子风暴引起的炎症迹象和多器官功能障碍。MIS-C的临床谱范围从轻度到重度，甚至涉及致命的多系统受累。为指导临床医生，我们评估了MIS-C病例的详细人口统计学特征、临床特征、实验室检查结果及预后。
我们对在土耳其科尼亚塞尔丘克大学医学院儿科传染病科接受治疗的MIS-C患者进行了一项回顾性研究。MIS-C患者被分为三个临床严重程度组（轻度、中度和重度），并分为三个年龄组（<5岁、5-10岁、>10岁）。我们根据疾病严重程度和年龄组比较了MIS-C病例的特征。
对36例MIS-C患儿进行了评估（男性占52.8%，中位年龄7.8岁）。在所有年龄组中，与川崎病（KD）重叠的临床谱是最常见的表现（69.4%）。最常见的临床症状为发热（100%）、黏膜皮肤皮疹（69.4%）和胃肠道症状（66.6%）。KD样临床谱与其他临床谱之间在超声心动图异常方面无统计学显著差异（p>0.05）。所有危及生命的心律失常均在重症病例中观察到。无患者死亡。
提高医生对MIS-C疾病的认识很重要，该疾病可表现为不同系统表现的不同组合，以便患者能够得到及时诊断和治疗。要点 • 一项单中心三级研究表明，MIS-C患儿可表现出除川崎病之外的不同临床谱。 • 心电图和超声心动图评估对MIS-C患儿的早期诊断很重要。 • 脑钠肽前体（Pro-BNP）可在急诊室用作对持续不明原因发热患儿的筛查试验，以确定MIS-C的早期心脏受累情况。 • MIS-C患儿缺乏所需生物制剂但预后良好可能与疾病早期使用静脉注射免疫球蛋白（IVIG）联合类固醇治疗有关。
