Divisions of Immunology.
Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Hosp Pediatr. 2022 Jul 1;12(7):e249-e254. doi: 10.1542/hpeds.2021-006426.
Multisystem inflammatory syndrome in children (MIS-C) and e-cigarette or vaping product use-associated lung injury (EVALI) have significant overlap in clinical features, which can contribute to delay in identification and treatment. The objectives of this report were to identify and describe features that are common in both diagnoses and those that may help distinguish EVALI from MIS-C, and to highlight the diagnostic challenges observed at our tertiary medical center.
We identified adolescents diagnosed with MIS-C who had respiratory or gastrointestinal symptoms and patients diagnosed with EVALI during the same time period. We compared demographics, history, clinical manifestations, laboratory findings, and features of the hospital course to determine areas of overlap between MIS-C and EVALI, as well as distinct features of each diagnosis. Mann-Whitney U test was used to compare continuous variables and Fisher's exact test was used to compare categorical variables.
We found that cardiovascular and mucocutaneous findings and thrombocytopenia were more common in MIS-C. EVALI patients had a higher degree of inflammation and history of antecedent weight loss. Providers at our institution were more likely to consider MIS-C than EVALI on the differential diagnosis, including in patients with vaping history and no evidence of previous severe acute respiratory syndrome coronavirus 2 infection.
This study emphasizes the need for a thorough collection of substance use history for all patients and consideration of EVALI in adolescents who present with respiratory compromise or gastrointestinal symptoms and systemic inflammation, particularly in the absence of severe acute respiratory syndrome coronavirus 2 exposure or cardiac findings characteristic of MIS-C.
儿童多系统炎症综合征（MIS-C）和电子烟或蒸气产品使用相关肺损伤（EVALI）在临床特征上有很大的重叠，这可能导致诊断和治疗的延误。本报告的目的是确定并描述这两种疾病共有的特征，以及可能有助于将 EVALI 与 MIS-C 区分开来的特征，并强调在我们的三级医疗中心观察到的诊断挑战。
我们确定了在同一时期患有呼吸系统或胃肠道症状的 MIS-C 患儿和被诊断为 EVALI 的患者。我们比较了人口统计学、病史、临床表现、实验室检查结果和住院过程中的特征，以确定 MIS-C 和 EVALI 之间的重叠区域，以及每个诊断的独特特征。使用 Mann-Whitney U 检验比较连续变量，使用 Fisher's 确切检验比较分类变量。
我们发现心血管和黏膜皮肤表现以及血小板减少症在 MIS-C 中更为常见。EVALI 患者的炎症程度更高，并有先前体重减轻的病史。我们机构的医生更倾向于在鉴别诊断中考虑 MIS-C 而不是 EVALI，包括有蒸气使用史且没有先前严重急性呼吸综合征冠状病毒 2 感染证据的患者。
本研究强调了需要对所有患者进行全面的物质使用史采集，并考虑在出现呼吸窘迫或胃肠道症状和全身炎症的青少年中出现 EVALI，特别是在没有严重急性呼吸综合征冠状病毒 2 暴露或 MIS-C 特征性心脏表现的情况下。
