Hébert Steven, Schmidt Marius, Topf Georg, Rieger Daniel, Klinge Jens, Vermehren Jan, Fusch Christoph, Grillhösl Christian, Schroth Michael, Toni Irmgard, Reutter Heiko, Morhart Patrick, Hanslik Gregor, Mulzer Linda, Woelfle Joachim, Hohberger Bettina, Hoerning André
Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany.
Hospital for Children and Adolescents Furth, 90766 Furth, Germany.
Children (Basel). 2023 Aug 9;10(8):1363. doi: 10.3390/children10081363.
Multisystemic Inflammatory Syndrome in children (MIS-C) is a rare autoimmune disorder occurring after a latency period following acute SARS-CoV-2 infection. The therapeutic regime of MIS-C is adapted to the therapy of the Kawasaki disease, as clinical symptoms are similar. Since the Kawasaki disease can potentially result in severe symptoms, which may even affect long-term health, it is essential to gain further knowledge about MIS-C. Thus, we aimed to investigate the incidence, symptoms, therapeutical procedure and outcome of MIS-C patients in the metropolitan area of Nuremberg-Erlangen during the SARS-CoV2 pandemic.
Retrospective analysis of clinical charts of MIS-C patients was carried out at three children's hospitals covering the medical care of the metropolitan area of Nuremberg-Erlangen in Germany. Demographic characteristics and symptoms at first visit, their clinical course, therapeutic regime and outcome were recorded within the time period January 2021-December 2022.
Analysis of 10 patients (5 male, 5 female) with MIS-C resulting in an incidence of 2.14/100.000 children. The median time between COVID-19 infection and admission to hospital was 5 weeks. The median age was 7 years. Symptoms comprised fever (100%), rash (70%), bilateral non-purulent conjunctivitis (70%) and urticaria (20%). At the time of presentation, diagnosis-defining inflammation parameters were increased and the range for C-reactive protein was 4.13 mg/dL to 28 mg/dL, with a median of 24.7 mg/dL. Procalcitonin was initially determined in six patients (1.92 ng/mL to 21.5 ng/mL) with a median value of 5.5 pg/mL. Two patients displayed leukocytosis and two displayed leukopenia. None of the patients presented coronary pathologies. Nine of the ten patients received intravenous immunoglobulin (IVIG) therapy. In addition, patients received intravenous steroids (80%) and acetylsalicylic acid (80%).
SARS-CoV virus may rarely exert multiorgan manifestations due to hyperinflammatory immunological processes. Within two years of the COVID-19 pandemic, we identified ten patients with COVID-induced MIS-C in the metropolitan area Nuremberg-Erlangen. In the description of the patient collective, we can confirm that MIS-C is distinguished from the Kawasaki disease by the lack of coronary manifestations. Interestingly, although having monitored all pediatric facilities in the investigated area, we find lower incidences of MIS-C compared to findings in the literature. In conclusion, an overestimation of incidences in the upcoming MIS-C during the pandemic needs to be considered.
儿童多系统炎症综合征（MIS-C）是一种罕见的自身免疫性疾病，发生在急性SARS-CoV-2感染后的潜伏期。由于临床症状相似，MIS-C的治疗方案与川崎病的治疗方案相适应。鉴于川崎病可能导致严重症状，甚至可能影响长期健康，进一步了解MIS-C至关重要。因此，我们旨在调查在SARS-CoV2大流行期间，纽伦堡-埃尔朗根大都市地区MIS-C患者的发病率、症状、治疗过程和结局。
对德国纽伦堡-埃尔朗根大都市地区提供医疗服务的三家儿童医院的MIS-C患者临床病历进行回顾性分析。记录2021年1月至2022年12月期间首次就诊时的人口统计学特征和症状、临床病程、治疗方案及结局。
对10例MIS-C患者（5例男性，5例女性）进行分析，发病率为2.14/100,000儿童。COVID-19感染至入院的中位时间为5周。中位年龄为7岁。症状包括发热（100%）、皮疹（70%）、双侧非脓性结膜炎（70%）和荨麻疹（20%）。就诊时，确诊炎症参数升高，C反应蛋白范围为4.13mg/dL至28mg/dL，中位数为24.7mg/dL。6例患者最初检测了降钙素原（1.92ng/mL至21.5ng/mL），中位数为5.5pg/mL。2例患者出现白细胞增多，2例出现白细胞减少。所有患者均未出现冠状动脉病变。10例患者中有9例接受了静脉注射免疫球蛋白（IVIG）治疗。此外，患者还接受了静脉类固醇（80%）和乙酰水杨酸（80%）治疗。
SARS-CoV病毒可能因过度炎症免疫过程而很少出现多器官表现。在COVID-19大流行的两年内，我们在纽伦堡-埃尔朗根大都市地区确定了10例由COVID引起的MIS-C患者。在对患者群体的描述中，我们可以确认MIS-C与川崎病的区别在于缺乏冠状动脉表现。有趣的是，尽管对调查区域内的所有儿科机构进行了监测，但我们发现MIS-C的发病率低于文献中的报道。总之，需要考虑在大流行期间即将出现的MIS-C发病率被高估的情况。
