Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Pediatric Cardiology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Postgrad Med. 2021 Nov;133(8):994-1000. doi: 10.1080/00325481.2021.1987732. Epub 2021 Oct 17.
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition resulting in excessive response of the immune system after SARS-CoV-2 infection. We report a single-center cohort of children with MIS-C, describing the spectrum of presentation, therapies, clinical course, and short-term outcomes.
This is a prospective observational study from to a tertiary pediatric rheumatology center including patients (aged 1 month to 21 years) diagnosed with MIS-C between April 2020-April 2021. Demographic, clinical, laboratory results and follow-up data were collected through the electronic patient record system and analyzed.
A total of 67 patients with MIS-C were included in the study. Fever was detected in all patients; gastrointestinal system symptoms were found in 67.2% of the patients, rash in 38.8%, conjunctivitis in 31.3%, hypotension in 26.9% myocarditis, and/or pericarditis in 22.4%, respectively. Respiratory symptoms were only in five patients (7.5%). Kawasaki Disease like presentation was found 37.3% of the patients. The mean duration of hospitalization was 11.8 7.07 days. Fifty-seven patients (85%) received intravenous immunoglobulin (IVIG), 45 (67%) received corticosteroids, 17 (25.3%) received anakinra, and one (1.5%) received tocilizumab. Seven of the patients (10.4%) underwent therapeutic plasma exchange (TPE). In 21 (31.3%) patients, a pediatric intensive care unit (PICU) was required in a median of 2 days. The first finding to improve was fever, while the first parameter to decrease was ferritin (median 6.5 days (IQR, 4-11.2 days)). Sixty-five patients were discharged home with a median duration of hospital stay of 10 days (IQR, 7-15 days).
Patients with MIS-C may have severe cardiac findings and intensive care requirements in admission and hospital follow-up. The vast majority of these findings improve with effective treatment without any sequelae until discharge and in a short time in follow-up. Although the pathogenesis and treatment plan of the disease are partially elucidated, follow-up studies are needed in terms of long-term prognosis and relapse probabilities.
儿童多系统炎症综合征（MIS-C）是一种罕见但严重的疾病，是由 SARS-CoV-2 感染后免疫系统过度反应引起的。我们报告了一个单中心的 MIS-C 患儿队列，描述了其临床表现、治疗方法、临床病程和短期结局。
这是一项前瞻性观察性研究，纳入 2020 年 4 月至 2021 年 4 月期间在一家三级儿科风湿病中心诊断为 MIS-C 的患儿（年龄 1 个月至 21 岁）。通过电子病历系统收集人口统计学、临床、实验室结果和随访数据，并进行分析。
共纳入 67 例 MIS-C 患儿。所有患儿均有发热；胃肠道症状占 67.2%，皮疹占 38.8%，结膜炎占 31.3%，低血压占 26.9%，心肌炎和（或）心包炎占 22.4%，分别。呼吸道症状仅见于 5 例（7.5%）。37.3%的患儿有川崎病样表现。住院平均时间为 11.8±7.07 天。57 例（85%）患儿接受静脉注射免疫球蛋白（IVIG），45 例（67%）患儿接受皮质类固醇治疗，17 例（25.3%）患儿接受阿那白滞素治疗，1 例（1.5%）患儿接受托珠单抗治疗。7 例（10.4%）患儿接受了治疗性血浆置换（TPE）。21 例（31.3%）患儿需要入住儿科重症监护病房（PICU），中位时间为 2 天。首先改善的是发热，而首先降低的是铁蛋白（中位数为 6.5 天（IQR，4-11.2 天））。65 例患儿出院，中位住院时间为 10 天（IQR，7-15 天）。
MIS-C 患儿在入院和住院随访时可能有严重的心脏表现和需要重症监护。这些发现中的绝大多数通过有效的治疗得到改善，并且在出院时和随访期间在短时间内没有任何后遗症。尽管该疾病的发病机制和治疗方案部分阐明，但需要进一步研究以了解其长期预后和复发概率。
