During the coronavirus disease 19 (COVID-19) pandemic, there has been an influx of children presenting with clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) and incomplete Kawasaki Disease, according to a study published in the American Journal of Emergency Medicine.

Researchers from Central Michigan University, Mount Pleasant, Michigan, conducted a retrospective review of medical records from a single center in Detroit, Michigan, of 34 children who presented at the emergency department with MIS-C between April 16 and July 7.

The median age was 6 years, 47% were boys, and 68% were Black. Children often presented with fever for at least 2 days (88.2%), anorexia (85.2%), abnormal electrocardiograms (60%), generalized abdominal pain (58.8%), diarrhea (52%), vomiting (41.1%), and shock (38.4%) requiring a vasopressor (29%). Respiratory symptoms were less commonly observed.

Signs of inflammation were common; the median concentration of C-reactive protein was 143±161.5 mg/L, ferritin was 331±342 ng/mL, and D-dimer was 2.3±2.3 mg/L.


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Over 79% of children were admitted directly to the intensive care unit and 15% were transferred to intensive care after a few hours due to decompensation. Among children in the intensive care unit, 16 (66.6%) were given vasopressor support, 8 (33.3%) required mechanical ventilation, and 2 (8.3%) required extra corporeal membrane oxygenation.

Nearly a quarter of patients (23.5%) tested positive for COVID-19 by real-time polymerase chain reaction (RT-PCR) and 72% had positive immunoglobulin G serology.

This study was limited by sample size and skewed demographic profile of the patient cohort.

“Clinicians need to be on high alert for MIS-C in previously healthy children,” investigators concluded. “Evidence of increased inflammation and myocardial injury should prompt immediate admission to the pediatric critical unit to optimize management and prevent morbidity and mortality.”

Reference

Sethuraman U, Kannikeswaran N, Ang J, et al. Multisystem inflammatory syndrome in children associated with novel coronavirus SARS-CoV-2: presentations to a pediatric emergency department in Michigan. Am J Emerg Med. 2020;S0735-6757(20)30931-1. doi:10.1016/j.ajem.2020.10.035.