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Okarska-Napierała M, Woźniak W, Mańdziuk J, Ludwikowska KM, Feleszko W, Grzybowski J, Panczyk M, Berdej-Szczot E, Zaryczański J, Górnicka B, Szenborn L, Kuchar E. Pathologic Analysis of Twenty-one Appendices From Children With Multisystem Inflammatory Syndrome Compared to Specimens of Acute Appendicitis: A Cross-sectional Study. Pediatr Infect Dis J 2024; 43:525-531. [PMID: 38753993 DOI: 10.1097/inf.0000000000004264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a rare, severe complication of coronavirus disease 2019, commonly involving the gastrointestinal tract. Some children with MIS-C undergo appendectomy before the final diagnosis. There are several hypotheses explaining the pathomechanism of MIS-C, including the central role of the viral antigen persistence in the gut, associated with lymphocyte exhaustion. We aimed to examine appendectomy specimens from MIS-C patients and assess their pathologic features, as well as the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens. METHODS In this cross-sectional study we included 21 children with MIS-C who underwent appendectomy. The control group included 21 sex- and age-matched children with acute appendicitis (AA) unrelated to SARS-CoV-2 infection. Histologic evaluation of appendiceal specimens included hematoxylin and eosin staining and immunohistochemical identification of lymphocyte subpopulations, programmed cell death protein-1 (PD-1) and SARS-CoV-2 nucleocapsid antigen. RESULTS Appendices of MIS-C patients lacked neutrophilic infiltrate of muscularis propria typical for AA (14% vs. 95%, P < 0.001). The proportion of CD20+ to CD5+ cells was higher in patients with MIS-C (P = 0.04), as was the proportion of CD4+ to CD8+ (P < 0.001). We found no proof of SARS-CoV-2 antigen presence, nor lymphocyte exhaustion, in the appendices of MIS-C patients. CONCLUSIONS The appendiceal muscularis of patients with MIS-C lack edema and neutrophilic infiltration typical for AA. SARS-CoV-2 antigens and PD-1 are absent in the appendices of children with MIS-C. These findings argue against the central role of SARS-CoV-2 persistence in the gut and lymphocyte exhaustion as the major triggers of MIS-C.
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Affiliation(s)
- Magdalena Okarska-Napierała
- From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Weronika Woźniak
- From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Mańdziuk
- From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Berdej-Szczot
- Department of Paediatrics and Paediatric Endocrinology, Upper-Silesian Paediatric Health Center School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Janusz Zaryczański
- Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland
| | | | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Ernest Kuchar
- From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
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Mattioli LB, Frosini M, Corazza I, Fiorino S, Zippi M, Micucci M, Budriesi R. Long COVID-19 gastrointestinal related disorders and traditional Chinese medicine: A network target-based approach. Phytother Res 2024; 38:2323-2346. [PMID: 38421118 DOI: 10.1002/ptr.8163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024]
Abstract
The significant number of individuals impacted by the pandemic makes prolonged symptoms after COVID-19 a matter of considerable concern. These are numerous and affect multiple organ systems. According to the World Health Organization (WHO), prolonged gastrointestinal issues are a crucial part of post-COVID-19 syndrome. The resulting disruption of homeostasis underscores the need for a therapeutic approach based on compounds that can simultaneously affect more than one target/node. The present review aimed to check for nutraceuticals possessing multiple molecular mechanisms helpful in relieving Long COVID-19-specific gastrointestinal symptoms. Specific plants used in Keywords Chinese Medicine (TCM) expected to be included in the WHO Global Medical Compendium were selected based on the following criteria: (1) they are widely used in the Western world as natural remedies and complementary medicine adjuvants; (2) their import and trade are regulated by specific laws that ensure quality and safety (3) have the potential to be beneficial in alleviating intestinal issues associated with Long COVID-19. Searches were performed in PubMed, Elsevier, Google Scholar, Scopus, Science Direct, and ResearchGate up to 2023. Cinnamomum cassia, Glycyrrhiza uralensis, Magnolia officinalis, Poria cocos, Salvia miltiorrhiza, Scutellaria baicalensis, and Zingiber officinalis were identified as the most promising for their potential impact on inflammation and oxidative stress. Based on the molecular mechanisms of the phytocomplexes and isolated compounds of the considered plants, their clinical use may lead to benefits in gastrointestinal diseases associated with Long COVID-19, thanks to a multiorgan and multitarget approach.
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Affiliation(s)
- Laura Beatrice Mattioli
- Department of Pharmacy and Biotechnology, Food Chemistry and Nutraceutical Lab, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Maria Frosini
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Ivan Corazza
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Sirio Fiorino
- Internal Medicine Unit, Azienda USL, Budrio Hospital, Bologna, Italy
| | - Maddalena Zippi
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Matteo Micucci
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
| | - Roberta Budriesi
- Department of Pharmacy and Biotechnology, Food Chemistry and Nutraceutical Lab, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Koyuncu H, Bükülmez A, Güngör A, Sarıkaya Y. Evaluation of acute terminal ileitis in children before and during the COVID-19 pandemic. J Pediatr Gastroenterol Nutr 2024; 78:197-203. [PMID: 38374549 DOI: 10.1002/jpn3.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The aim of this study was to examine the clinical features of acute terminal ileitis in children and evaluate its rate before and during the COVID-19 pandemic. METHODS This retrospective study was performed in our pediatric emergency department between 2018 and 2022. The records of 5363 patients who required abdominal imaging due to acute abdomen were analyzed, and 143 patients with terminal ileitis were included. The rate and etiological causes were compared during and before the COVID-19 pandemic. RESULTS The rate of acute terminal ileitis has increased over the years. The fastest increase was in 2021, when the COVID-19 pandemic was experienced. While 59 (41.2%) patients showed acute nonspecific ileitis, the most common etiologic cause that could be identified was acute gastroenteritis. It was determined that multisystem inflammatory syndrome in children was among the causes of ileitis after the COVID-19 pandemic and was one of the top three causes. CONCLUSIONS Acute terminal ileitis, which has many etiologies, is one of the rare radiological findings in acute abdominal pain. Examination and laboratory findings are not specific. Guidelines are needed for the investigation of the underlying etiology of acute terminal ileitis in children. The incidence of acute terminal ileitis is increasing, and the increase has been found to be faster after the COVID-19 pandemic.
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Affiliation(s)
- Hilal Koyuncu
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşegül Bükülmez
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşe Güngör
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Andargie TE, Roznik K, Redekar N, Hill T, Zhou W, Apalara Z, Kong H, Gordon O, Meda R, Park W, Johnston TS, Wang Y, Brady S, Ji H, Yanovski JA, Jang MK, Lee CM, Karaba AH, Cox AL, Agbor-Enoh S. Cell-free DNA reveals distinct pathology of multisystem inflammatory syndrome in children. J Clin Invest 2023; 133:e171729. [PMID: 37651206 PMCID: PMC10617770 DOI: 10.1172/jci171729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare but life-threatening hyperinflammatory condition induced by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes pediatric COVID-19 (pCOVID-19). The relationship of the systemic tissue injury to the pathophysiology of MIS-C is poorly defined. We leveraged the high sensitivity of epigenomics analyses of plasma cell-free DNA (cfDNA) and plasma cytokine measurements to identify the spectrum of tissue injury and glean mechanistic insights. Compared with pediatric healthy controls (pHCs) and patients with pCOVID-19, patients with MIS-C had higher levels of cfDNA primarily derived from innate immune cells, megakaryocyte-erythroid precursor cells, and nonhematopoietic tissues such as hepatocytes, cardiac myocytes, and kidney cells. Nonhematopoietic tissue cfDNA levels demonstrated significant interindividual variability, consistent with the heterogenous clinical presentation of MIS-C. In contrast, adaptive immune cell-derived cfDNA levels were comparable in MIS-C and pCOVID-19 patients. Indeed, the cfDNA of innate immune cells in patients with MIS-C correlated with the levels of innate immune inflammatory cytokines and nonhematopoietic tissue-derived cfDNA, suggesting a primarily innate immunity-mediated response to account for the multisystem pathology. These data provide insight into the pathogenesis of MIS-C and support the value of cfDNA as a sensitive biomarker to map tissue injury in MIS-C and likely other multiorgan inflammatory conditions.
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Affiliation(s)
- Temesgen E. Andargie
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
- Department of Biology, Howard University, Washington DC, USA
| | - Katerina Roznik
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Neelam Redekar
- Integrated Data Sciences Section, Research Technologies Branch, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Tom Hill
- Integrated Data Sciences Section, Research Technologies Branch, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Weiqiang Zhou
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zainab Apalara
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
| | - Hyesik Kong
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
| | - Oren Gordon
- Infectious Diseases Unit, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rohan Meda
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
| | - Woojin Park
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
| | - Trevor S. Johnston
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Yi Wang
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheila Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland, USA
| | - Hongkai Ji
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland, USA
| | - Moon K. Jang
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
| | - Clarence M. Lee
- Department of Biology, Howard University, Washington DC, USA
| | - Andrew H. Karaba
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA. GFAfT is detailed in Supplemental Acknowledgments
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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Rassi CE, Zareef R, Honeini R, Latouf C, Bitar F, Arabi M. Multisystem inflammatory syndrome in children: another COVID-19 sequel. Cardiol Young 2023; 33:1418-1428. [PMID: 37409933 DOI: 10.1017/s1047951123001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
With the rapid expansion of the COVID-19 pandemic, the disease burden and its consequences on the paediatric population has been progressively recognised. Although COVID-19 infection in children presents as asymptomatic to mild illness, instances of hyperinflammation and multi-organ involvement following the viral infection have been described. This condition, known as the multisystem inflammatory syndrome in children (MIS-C), has gained a wide global attention. Despite the global efforts to uncover the disease characteristics and management, a clear pathogenesis and a unified treatment regimen have not been reached yet. This paper tackles the epidemiology of the MIS-C, discusses its suggested pathogenesis, drives through its varying clinical presentations, and evaluates the different treatment regimens employed in managing MIS-C.
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Affiliation(s)
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawan Honeini
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Latouf
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Children's Heart Center, American University of Beirut Medical Center, Beirut, Lebanon
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Röckert Tjernberg A, Malmborg P, Mårild K. Coronavirus disease 2019 and gastrointestinal disorders in children. Therap Adv Gastroenterol 2023; 16:17562848231177612. [PMID: 37305380 PMCID: PMC10243097 DOI: 10.1177/17562848231177612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
During the past 3 years, the coronavirus disease 2019 (COVID-19) pandemic has had a great impact on people all over the world. However, it has become evident that disease manifestations and severity differ across age groups. Most children have a milder disease course than adults but possibly more pronounced gastrointestinal (GI) symptoms. Given the child's developing immune system, the impact of COVID-19 on disease development may differ compared to adults. This study reviews the potential bi-directional relationship between COVID-19 and GI diseases in children, focusing on common pediatric conditions such as functional GI disorders (FGID), celiac disease (CeD), and inflammatory bowel disease (IBD). Children with GI diseases, in general, and CeD and IBD, in particular, do not seem to have an increased risk of severe COVID-19, including risks of hospitalization, critical care need, and death. While infections are considered candidate environmental factors in both CeD and IBD pathogenesis, and specific infectious agents are known triggers for FGID, there is still not sufficient evidence to implicate COVID-19 in the development of either of these diseases. However, given the scarcity of data and the possible latency period between environmental triggers and disease development, future investigations in this field are warranted.
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Affiliation(s)
- Anna Röckert Tjernberg
- Department of Pediatrics, Kalmar County Hospital, Region Kalmar County, Kalmar S-391 85, Sweden
| | - Petter Malmborg
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karl Mårild
- Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
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Thiriard A, Meyer B, Eberhardt CS, Loevy N, Grazioli S, Adouan W, Fontannaz P, Marechal F, L’Huillier AG, Siegrist CA, Georges D, Putignano A, Marchant A, Didierlaurent AM, Blanchard-Rohner G. Antibody response in children with multisystem inflammatory syndrome related to COVID-19 (MIS-C) compared to children with uncomplicated COVID-19. Front Immunol 2023; 14:1107156. [PMID: 37006315 PMCID: PMC10050384 DOI: 10.3389/fimmu.2023.1107156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectivesTo comprehensively analyze the quality of the antibody response between children with Multisystem inflammatory syndrome (MIS-C) and age-matched controls at one month after SARS-CoV-2 exposure, and infected in the same time-period.MethodsSerum from 20 MIS-C children at admission, and 14 control children were analyzed. Antigen specific antibody isotypes and subclasses directed against various antigens of SARS-CoV-2 as well as against human common coronavirus (HCoVs) and commensal or pathogenic microorganisms were assessed by a bead-based multiplexed serological assay and by ELISA. The functionality of these antibodies was also assessed using a plaque reduction neutralization test, a RBD-specific avidity assay, a complement deposition assay and an antibody-dependent neutrophil phagocytosis (ADNP) assay.ResultsChildren with MIS-C developed a stronger IgA antibody response in comparison to children with uncomplicated COVID-19, while IgG and IgM responses are largely similar in both groups. We found a typical class-switched antibody profile with high level of IgG and IgA titers and a measurable low IgM due to relatively recent SARS-CoV-2 infection (one month). SARS-CoV-2-specific IgG antibodies of MIS-C children had higher functional properties (higher neutralization activity, avidity and complement binding) as compared to children with uncomplicated COVID-19. There was no difference in the response to common endemic coronaviruses between both groups. However, MIS-C children had a moderate increase against mucosal commensal and pathogenic strains, reflecting a potential association between a disruption of the mucosal barrier with the disease.ConclusionEven if it is still unclear why some children develop a MIS-C, we show here that MIS-C children produce higher titers of IgA antibodies, and IgG antibodies with higher functionality, which could reflect the local gastro-intestinal mucosal inflammation potentially induced by a sustained SARS-CoV-2 gut infection leading to continuous release of SARS-CoV-2 antigens.
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Affiliation(s)
- Anaïs Thiriard
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Christiane S. Eberhardt
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Natasha Loevy
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Wafae Adouan
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Paola Fontannaz
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Fabienne Marechal
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Daphnée Georges
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Enzymology and Protein Folding, Centre for Protein Engineering, InBioS, University of Liège, Liège, Belgium
| | - Antonella Putignano
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud M. Didierlaurent
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Geraldine Blanchard-Rohner
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- Pediatric Immunology and Vaccinology Unit, Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- *Correspondence: Geraldine Blanchard-Rohner,
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8
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Cappell MS, Tobi M, Friedel DM. The Impact of COVID-19 Infection on Miscellaneous Inflammatory Disorders of the Gastrointestinal Tract. Gastroenterol Clin North Am 2023; 52:115-138. [PMID: 36813420 PMCID: PMC9537253 DOI: 10.1016/j.gtc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The novel coronavirus pandemic of COVID-19 has emerged as a highly significant recent threat to global health with about 600,000,000 known infections and more than 6,450,000 deaths worldwide since its emergence in late 2019. COVID-19 symptoms are predominantly respiratory, with mortality largely related to pulmonary manifestations, but the virus also potentially infects all parts of the gastrointestinal tract with related symptoms and manifestations that affect patient treatment and outcome. COVID-19 can directly infect the gastrointestinal tract because of the presence of widespread angiotensin-converting enzyme 2 receptors in the stomach and small intestine that can cause local COVID-19 infection and associated inflammation. This work reviews the pathopysiology, clinical manifestations, workup, and treatment of miscellaneous inflammatory disorders of the gastrointestinal tract other than inflammatory bowel disease.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Aleda E. Lutz Veterans Hospital, Gastroenterology Service, Main Building, Room 3212, 1500 Weiss Street, Saginaw, MI 48602, USA.
| | - Martin Tobi
- Department of Research and Development, John D. Dingell Veterans Affairs Medical Center, 4747 John R. Street, Detroit, MI 48201, USA
| | - David M Friedel
- Division of Therapeutic Endoscopy, Division of Gastroenterology, Department of Medicine, NY of New York University Langone Hospital, 259 1st Street, Mineola, NY 11501, USA
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9
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Sag S, Sonmez Y, Sahin EG, Guzel B, Cay A. Small bowel ischaemia secondary to COVID-19 disease in children: A case report and review of the literature. J Paediatr Child Health 2023; 59:567-569. [PMID: 36722829 DOI: 10.1111/jpc.16341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Sefa Sag
- Department of Pediatric Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yagmur Sonmez
- Department of Pediatric Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ebru G Sahin
- Department of Pediatrics, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bulent Guzel
- Department of Pediatrics, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali Cay
- Department of Pediatric Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Davoodi M, Pouladfar G, Kadivar MR, Dehghan A, Askarisarvestani A, Hamzavi SS. Terminal ileitis and cytotoxic lesion of corpus callosum as the presenting features of Multisystem inflammatory syndrome in children (MIS-C): a case report. BMC Pediatr 2023; 23:15. [PMID: 36627589 PMCID: PMC9831879 DOI: 10.1186/s12887-022-03707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/24/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a post-viral inflammatory vasculopathy characterized by persistent fever, multiorgan dysfunction, significant laboratory markers of inflammation, lack of an alternative diagnosis, and prior SARS-CoV-2 infection or exposure in children and adolescents. The most common early symptoms include a prolonged fever, as well as dermatologic, mucocutaneous, and gastrointestinal symptoms such abdominal pain, vomiting, and diarrhea. CASE PRESENTATION We present a pediatric patient with multisystem inflammatory syndrome with the development of abdominal pain and seizure who was found to have a circumferential wall thickening of the terminal ileum and ileocecal junction in abdominal CT scan. The brain MRI of the patient showed cytotoxic lesions of the corpus callosum (CLOCC) which had hypersignal intensity with a few diffusion restrictions in the splenium of the corpus callosum. CONCLUSION This case is being reported to raise awareness of MIS-C presenting characteristics. Given the rising number of MIS-C patients and a lack of understanding regarding early diagnostic clinical characteristics and therapy, further research into clinical presentations, treatment, and outcomes is urgently needed.
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Affiliation(s)
- Marzieh Davoodi
- grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Pouladfar
- grid.412571.40000 0000 8819 4698Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Rahim Kadivar
- grid.412571.40000 0000 8819 4698Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Dehghan
- grid.412571.40000 0000 8819 4698Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Askarisarvestani
- grid.412571.40000 0000 8819 4698Division of Allergy and Clinical Immunology, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Sedigheh Hamzavi
- grid.412571.40000 0000 8819 4698Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Long F, Zhu S, Wang Z, Zhang S, He J, Ge X, Ning J. Update on the treatment of multisystem inflammatory syndrome in children associated with COVID-19. Future Virol 2022:10.2217/fvl-2022-0048. [PMID: 36699562 PMCID: PMC9853872 DOI: 10.2217/fvl-2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023]
Abstract
In late 2019, SARS-CoV-2 was detected in China and spread worldwide. In rare cases, children who were infected with COVID-19 may develop multisystem inflammatory syndrome (MIS-C), which could have higher mortality than COVID-19 itself. Therefore, diagnosis and management are critical for treatment. Specifically, most of the initial treatment options of MIS-C choose intravenous immunoglobulin (IVIG) and steroids as the first-line treatment for patients. Moreover, antagonists of some cytokines are used as potential future therapeutics. Of note, therapeutic plasmapheresis can be used as a treatment for refractory severe MIS-C. We believe that each patient, especially those with comorbid conditions, should have individualized treatment based on both multidisciplinary consensus approach and expert opinion.
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Affiliation(s)
- Fangyuan Long
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Shiheng Zhu
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Zeguang Wang
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Shungeng Zhang
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Jinlong He
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Xinbin Ge
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Jun Ning
- 2Department of Paediatrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272029, China,Author for correspondence:
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12
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Imaging of Right Lower Quadrant Pain in Children and Adolescents: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 220:767-779. [PMID: 36416395 DOI: 10.2214/ajr.22.28358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Right lower quadrant (RLQ) pain is a common clinical presentation in children, and accurate clinical diagnosis remains challenging given that this nonspecific presentation is associated with numerous surgical and nonsurgical conditions. The broad differential diagnosis varies by patient age and sex. Important considerations in the selection of a diagnostic imaging strategy include the sequencing, performance, and cost of tests. This article provides a comprehensive narrative review of the diagnostic imaging of RLQ pain in children and adolescents, including a discussion of the complementary roles of ultrasound, CT, and MRI; description of key imaging findings based on available evidence; and presentation of salient differential diagnoses. Subspecialized pediatric emergency medicine and surgical perspectives are also provided as further clinical insight into this common, but often challenging, scenario. Finally, the current status of imaging of RLQ pain in children and adolescents is summarized on the basis of expert consensus.
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13
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Borczuk AC, Yantiss RK. The pathogenesis of coronavirus-19 disease. J Biomed Sci 2022; 29:87. [PMID: 36289507 PMCID: PMC9597981 DOI: 10.1186/s12929-022-00872-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/20/2022] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) is the causal agent of coronavirus disease-2019 (COVID-19), a systemic illness characterized by variably severe pulmonary symptoms, cardiac conduction abnormalities, diarrhea, and gastrointestinal bleeding, as well as neurologic deficits, renal insufficiency, myalgias, endocrine abnormalities, and other perturbations that reflect widespread microvascular injury and a pro-inflammatory state. The mechanisms underlying the various manifestations of viral infection are incompletely understood but most data suggest that severe COVID-19 results from virus-driven perturbations in the immune system and resultant tissue injury. Aberrant interferon-related responses lead to alterations in cytokine elaboration that deplete resident immune cells while simultaneously recruiting hyperactive macrophages and functionally altered neutrophils, thereby tipping the balance from adaptive immunity to innate immunity. Disproportionate activation of these macrophages and neutrophils further depletes normal activity of B-cells, T-cells, and natural killer (NK) cells. In addition, this pro-inflammatory state stimulates uncontrolled complement activation and development of neutrophil extracellular traps (NETS), both of which promote the coagulation cascade and induce a state of “thrombo-inflammation”. These perturbations have similar manifestations in multiple organ systems, which frequently show pathologic findings related to microvascular injury and thrombosis of large and small vessels. However, the pulmonary findings in patients with severe COVID-19 are generally more pronounced than those of other organs. Not only do they feature inflammatory thromboses and endothelial injury, but much of the parenchymal damage stems from failed maturation of alveolar pneumocytes, interactions between type 2 pneumocytes and non-resident macrophages, and a greater degree of NET formation. The purpose of this review is to discuss the pathogenesis underlying organ damage that can occur in patients with SARS-CoV-2 infection. Understanding these mechanisms of injury is important to development of future therapies for patients with COVID-19, many of which will likely target specific components of the immune system, particularly NET induction, pro-inflammatory cytokines, and subpopulations of immune cells.
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Affiliation(s)
- Alain C. Borczuk
- grid.512756.20000 0004 0370 4759Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, NY USA
| | - Rhonda K. Yantiss
- grid.5386.8000000041936877XDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065 USA
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14
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Tong CW, Jiwane A. A complicated case of terminal ileitis post-COVID-19 infection requiring bowel resection. J Surg Case Rep 2022; 2022:rjac457. [PMID: 36348639 PMCID: PMC9629472 DOI: 10.1093/jscr/rjac457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, there have been reports of children developing systemic hyperinflammatory response to COVID-19 infection, known as Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS). Here we would like to discuss a case of a 15-year-old male with PIMS-TS presenting as complicated terminal ileitis, requiring ileocaecal resection. Histopathologic findings of the ileocaecal specimen revealed thickened bowel mucosa, with features of granulomatous inflammation similar to Crohn’s disease, without features of intestinal vasculitis or viral particles. His post-operative course was complicated by fresh rectal bleeding, requiring urgent blood transfusion and endoscopy. Source of bleeding was not identified and his bleeding self-resolved. Gut biopsies of the remaining bowel taken during endoscopy were normal. Although this case suggests that the inflammatory process is focal to the terminal ileum with a good short-term prognosis, further follow-up is required to assess for long-term effects and risks of bowel disease.
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Affiliation(s)
- Chai Wei Tong
- Department of Paediatric Surgery, Sydney Children’s Hospital , Randwick, New South Wales , Australia
| | - Ashish Jiwane
- Department of Paediatric Surgery, Sydney Children’s Hospital , Randwick, New South Wales , Australia
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15
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Sayed IA, Bhalala U, Strom L, Tripathi S, Kim JS, Michaud K, Chiotos K, Dapul HR, Gharpure VP, Bjornstad EC, Heneghan JA, Irby K, Montgomery V, Gupta N, Gupta M, Boman K, Bansal V, Kashyap R, Walkey AJ, Kumar VK, Gist KM. Gastrointestinal Manifestations in Hospitalized Children With Acute SARS-CoV-2 Infection and Multisystem Inflammatory Condition: An Analysis of the VIRUS COVID-19 Registry. Pediatr Infect Dis J 2022; 41:751-758. [PMID: 35622434 PMCID: PMC9359679 DOI: 10.1097/inf.0000000000003589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C). METHODS Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational, multicenter international cohort study of hospitalized children with acute COVID-19 or MIS-C from March 2020 to November 2020. The primary outcome measure was critical COVID-19 illness. Multivariable models were performed to assess for associations of GI involvement with the primary composite outcome in the entire cohort and a subpopulation of patients with MIS-C. Secondary outcomes included prolonged hospital length of stay defined as being >75th percentile and mortality. RESULTS Of the 789 patients, GI involvement was present in 500 (63.3%). Critical illness occurred in 392 (49.6%), and 18 (2.3%) died. Those with GI involvement were older (median age of 8 yr), and 18.2% had an underlying GI comorbidity. GI symptoms and liver derangements were more common among patients with MIS-C. In the adjusted multivariable models, acute COVID-19 was no associated with the primary or secondary outcomes. Similarly, despite the preponderance of GI involvement in patients with MIS-C, it was also not associated with the primary or secondary outcomes. CONCLUSIONS GI involvement is common in hospitalized children with acute COVID-19 and MIS-C. GI involvement is not associated with critical illness, hospital length of stay or mortality in acute COVID-19 or MIS-C.
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Affiliation(s)
- Imran A. Sayed
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | - Utpal Bhalala
- The Children’s Hospital of San Antonio, San Antonio and Baylor College of Medicine, Houston, Texas
| | - Larisa Strom
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Sandeep Tripathi
- Department of Pediatrics, OSF Saint Francis Medical Centre/University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - John S. Kim
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | - Kristina Michaud
- The Children’s Hospital of San Antonio, San Antonio and Baylor College of Medicine, Houston, Texas
| | - Kathleen Chiotos
- Division of Critical Care and Anesthesia, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heda R. Dapul
- Division of Critical Care Medicine, Department of Pediatrics, NYU Langone Medical Center, New York, New York
| | - Varsha P. Gharpure
- Division of Critical Care Medicine, Department of Pediatrics, Advocate Children’s Hospital, Park Ridge, Illinois
| | - Erica C. Bjornstad
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julia A. Heneghan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Katherine Irby
- Division of Critical Care Medicine, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Vicki Montgomery
- Division of Critical Care Medicine, Department of Pediatrics, University of Louisville and Norton Children’s Hospital, Louisville, Kentucky
| | - Neha Gupta
- Division of Critical Care Medicine, Department of Pediatrics, NYU Langone Medical Center, New York, New York
| | - Manoj Gupta
- Division of Pediatric Cardiology, Department of Pediatrics, Lincoln Hospital, Bronx, New York
| | - Karen Boman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rahul Kashyap
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Allan J. Walkey
- Division of Pulmonary and Critical Care, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Vishakha K. Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - Katja M. Gist
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
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16
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Nasher O, Friend A, Lakshminarayanan B, Turner K, Wood M, Deri A, Ingham D. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS) — A mimic of intra-abdominal malignancy. BMJ Case Rep 2022; 15:15/8/e249668. [PMID: 36028239 PMCID: PMC9422851 DOI: 10.1136/bcr-2022-249668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report the case of a school-aged boy who presented with clinical features suggesting acute appendicitis. However, further imaging which included CT, demonstrated an inflammatory mass involving the transverse colon raising the suspicion of lymphoma. He then developed intestinal obstruction, and in view of the rapid progression of the disease, he was thought to have non-Hodgkin’s lymphoma. He underwent an open excisional biopsy, which revealed a necroinflammatory process and no suggestion of lymphoma or an alternative malignancy or specific diagnosis. His steroid treatment was stopped, and he made a good recovery postoperatively. Positive COVID-19 antibodies, positive response to steroids, results and clinical features were consistent with paediatric inflammatory multisystem syndrome (PIMS-TS), with extensive investigation not offering an alternative diagnosis. While PIMS-TS is a relatively new entity, we believe that this case highlights the importance of it being considered a differential diagnosis of a child presenting with an inflammatory mass.
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17
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Journal of Pediatric Gastroenterology and Nutrition-The Highlights of 2021. J Pediatr Gastroenterol Nutr 2022; 74:721-725. [PMID: 35849502 DOI: 10.1097/mpg.0000000000003480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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18
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Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19? J Clin Med 2022; 11:jcm11102765. [PMID: 35628892 PMCID: PMC9143677 DOI: 10.3390/jcm11102765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 01/14/2023] Open
Abstract
Background: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. Gastrointestinal manifestations are prominent in children with PIMS-TS/MIS-C. Thus, it is challenging to differentiate this condition from an exacerbation of inflammatory bowel disease (IBD). We aimed to present the clinical characteristics, and diagnostic and therapeutic difficulties in patients with overlapping IBD and PIMS-TS/MIS-C; Methods: We reviewed medical records of children hospitalized due to overlapping IBD and PIMS-TS/MIS-C in a single pediatric hospital from December 2020 to December 2021; Results: There were four children with overlapping IBD flare and PIMS-TS/MIS-C. In three cases, IBD recognition preceded PIMS-TS/MIS-C onset and PIMS-TS/MIS-C occurred during anti-inflammatory therapy of IBD. All children presented with gastrointestinal symptoms at PIMS-TS/MIS-C onset. All patients received IVIG and ASA treatment. In three children there was a need to use steroids to resolve PIMS-TS/MIS-C symptoms. One child was vaccinated against COVID-19; Conclusions: SARS-CoV-2 infection may affect patients with underlying inflammatory conditions such as IBD, inducing systemic symptoms of PIMS-TS/MIS-C, and probably triggering IBD after PIMS-TS/MIS-C. The resemblance of clinical presentations is the main source of diagnostic and therapeutic challenges in PIMS-TS/MIS-C in patients with underlying IBD.
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19
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Randhawa MS, Angurana SK, Nallasamy K, Kumar M, Ravikumar N, Awasthi P, Ghosh A, Ratho RK, Minz RW, Kumar RM, Bansal A, Jayashree M. Comparison of Multisystem Inflammatory Syndrome (MIS-C) and Dengue in Hospitalized Children. Indian J Pediatr 2022:10.1007/s12098-022-04184-2. [PMID: 35511400 PMCID: PMC9068862 DOI: 10.1007/s12098-022-04184-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Multisystem inflammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profile of children admitted with MIS-C and dengue were compared to understand their presentation at the outset. METHODS This was a retrospective study of children ≤ 12 y admitted with MIS-C (WHO definition) or laboratory-confirmed dengue between August 2020 and January 2021 at a tertiary center in North India. RESULTS A total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had significantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140 × 109/L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable. CONCLUSION In hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.
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Affiliation(s)
- Manjinder Singh Randhawa
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Suresh Kumar Angurana
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Karthi Nallasamy
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Mahendra Kumar
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Namita Ravikumar
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Puspraj Awasthi
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Arnab Ghosh
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - R K Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rohit Manoj Kumar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Muralidharan Jayashree
- Pediatric Emergency and Intensive Care Units, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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20
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Boybeyi-Turer O, Ozsurekci Y, Gurlevik SL, Oygar PD, Soyer T, Tanyel FC. Management of acute abdomen during the active disease course of COVID-19 and multisystem inflammatory syndrome in children. Surg Today 2022; 52:1313-1319. [PMID: 35513506 PMCID: PMC9070979 DOI: 10.1007/s00595-022-02512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the management of children with severe gastrointestinal symptoms during the disease course of COVID-19 and multisystem inflammatory syndrome (MIS-C). Methods After ethical approval, we reviewed the medical records, retrospectively, of children with COVID-19 or MIS-C requiring surgical consultation for severe gastrointestinal symptoms. Results The subjects comprised 15 children, 13 with MIS-C and 2 with COVID-19. Twelve children (80%) had been in known close contact with a person with SARS-CoV-19 and 13 were positive for Anti-SARS-CoV-2 IgG. All the children had experienced fever for at least 1 day and had signs of involvement of two or more systems. Three patients required surgical intervention: one underwent surgical exploration with a presumptive diagnosis of acute appendicitis in the referring center and was transported to our center following clinical deterioration, where a diagnosis of MIS-C was confirmed; and the remaining two developed appendicitis during hospitalization for COVID-19. All three patients had a longer duration of abdominal pain, a higher number of lymphocytes, and a lower level of inflammatory markers than the non-surgically managed patients. None of the patients presenting with MIS-C underwent surgical exploration. Conclusion Gastrointestinal involvement may mimic acute abdomen in children with COVID-19. Thus, children presenting with acute abdomen in the pandemic era require careful evaluation and prompt diagnosis to avoid unnecessary surgical intervention.
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Affiliation(s)
- Ozlem Boybeyi-Turer
- Faculty of Medicine, Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey.
| | - Yasemin Ozsurekci
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Sibel Lacinel Gurlevik
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Pembe Derin Oygar
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Tutku Soyer
- Faculty of Medicine, Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Faculty of Medicine, Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey
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21
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Pegoraro F, Trapani S, Indolfi G. Gastrointestinal, hepatic and pancreatic manifestations of COVID-19 in children. Clin Res Hepatol Gastroenterol 2022; 46:101818. [PMID: 34607068 PMCID: PMC8486685 DOI: 10.1016/j.clinre.2021.101818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a well-established respiratory tract pathogen. Recent studies in adults and children have shown an increasing number of patients reporting gastrointestinal manifestations of SARS-CoV-2 infection such as diarrhoea, nausea, vomiting and abdominal pain. SARS-CoV-2 RNA can be detected in faeces for an extended period, even after respiratory samples have tested negative and patients are asymptomatic. However, faecal-oral transmission has not yet been proven. In this article, the latest evidence on gastrointestinal, hepato-biliary, and pancreatic manifestations in children with coronavirus disease-19 and multisystem inflammatory syndrome will be analysed.
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Affiliation(s)
| | - Sandra Trapani
- Department of Health Science, Meyer Children's Hospital, Firenze, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, Meyer Children's Hospital, Firenze, Italy,Correspondence to: NEUROFARBA Department, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy
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22
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Meshaka R, Whittam FC, Guessoum M, Eleti S, Shelmerdine SC, Arthurs OJ, McHugh K, Hiorns MP, Humphries PD, Calder AD, Easty MJ, Gaynor EP, Watson T. Abdominal US in Pediatric Inflammatory Multisystem Syndrome Associated with SARS-CoV-2 (PIMS-TS). Radiology 2022; 303:173-181. [PMID: 34874199 PMCID: PMC8961721 DOI: 10.1148/radiol.211737] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Children with pediatric inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also known as multisystem inflammatory syndrome in children, present with abdominal pain among other nonspecific symptoms. Although initial imaging features of PIMS-TS have been reported, the duration of sonographic features remains unknown. Purpose To describe the abdominal US features of PIMS-TS at initial presentation and follow-up. Materials and Methods A retrospective review of children and young adults presenting with clinical features suspicious for PIMS-TS between April 2020 and June 2021 was carried out. US features were documented and reviewed at initial presentation and follow-up. Descriptive statistics were used and interobserver variability was calculated. Results Of 140 children and young adults presenting with suspected PIMS-TS, 120 had confirmed PIMS-TS (median age, 9 years; interquartile range, 7-12 years; 65 male patients) and 102 underwent abdominal US at presentation. PIMS-TS was present as a single abnormality in 109 of the 120 patients (91%) and abdominal symptoms were present in 104 of the 109 (95%). US examinations were abnormal in 86 of 102 patients (84%), with ascites being the most common abnormality in 65 (64%; 95% CI: 54, 73). Bowel wall thickening was present at US in 14 of the 102 patients (14%; 95% CI: 7, 20) and mesenteric inflammation was present in 16 (16%; 95% CI: 9, 23); all of these patients presented with abdominal symptoms. Among the patients with bowel wall thickening, the distal and terminal ileum were most involved (eight of 14 patients, 57%). Abdominal symptoms decreased to seven of 56 patients (13%) in those followed up at 6 months. Thirty-eight patients underwent follow-up US, and the presence of bowel inflammation had decreased to three of 27 patients (11%; 95% CI: -1, 23) in those followed up for less than 2 months and 0 of 17 (0%) in those followed up for more than 2 months. Conclusion Of 102 patients with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 who underwent US at presentation, 14 (14%) had abdominal US findings of bowel inflammation and 16 (16%) had mesenteric edema. All US abnormalities resolved after 2 months. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by van Rijn and Pajkrt in this issue.
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Affiliation(s)
- Riwa Meshaka
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Fern C Whittam
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Myriam Guessoum
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Saigeet Eleti
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Susan C Shelmerdine
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Owen J Arthurs
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Kieran McHugh
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Melanie P Hiorns
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Paul D Humphries
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Alistair D Calder
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Marina J Easty
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Edward P Gaynor
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Tom Watson
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
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Rouva G, Vergadi E, Galanakis E. Acute abdomen in multisystem inflammatory syndrome in children: A systematic review. Acta Paediatr 2022; 111:467-472. [PMID: 34751972 DOI: 10.1111/apa.16178] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022]
Abstract
AIM Multisystem inflammatory syndrome in children (MIS-C), a rare severe complication of SARS-CoV-2 infection, has been recently reported to mimic acute abdomen and lead to surgical interventions, posing challenges for clinicians. In this systematic review, we evaluated the rate of acute abdomen and abdominal surgical emergencies in children with MIS-C. METHODS Systematic review of all MIS-C cases presented with acute abdomen. RESULTS A total of 385 patients with MIS-C, from 38 studies, were included. Gastrointestinal manifestations were prominent in 233/385 (60.5%) children. Acute abdomen was noted in 72/385 (18.7%) of MIS-C cases and in 72/233 (30.9%) of MIS-C cases with gastrointestinal symptoms. Final diagnoses were mostly non-surgical (55/72, 76.4%), such as mesenteric lymphadenitis (23/72, 31.9%), terminal ileitis/ileocolitis (19/72, 26.4%), free abdominal fluid/ascites (8/72, 11.1%) and paralytic ileus (3/72, 4.2%). Laparotomy was performed in 35/72 (48.6%) of children with MIS-C, and acute abdomen and was proven unnecessary in 18/35 (51.4%) cases. True abdominal surgical emergencies, such as appendicitis and obstructive ileus, were confirmed in 17/72 (23.6%) cases. CONCLUSION MIS-C often presents with acute abdomen, mostly due to non-surgical intestinal inflammatory pathology. However, surgical complications occur in patients with MIS-C; therefore, a high index of suspicion should remain.
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Affiliation(s)
- Glykeria Rouva
- Department of Paediatrics University General Hospital of Heraklion Heraklion Greece
| | - Eleni Vergadi
- Department of Paediatrics University General Hospital of Heraklion Heraklion Greece
- Department of Μother and Child, School of Medicine University of Crete Heraklion Greece
| | - Emmanouil Galanakis
- Department of Paediatrics University General Hospital of Heraklion Heraklion Greece
- Department of Μother and Child, School of Medicine University of Crete Heraklion Greece
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24
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Imaging findings in acute pediatric coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome in children (MIS-C). Pediatr Radiol 2022; 52:1985-1997. [PMID: 35616701 PMCID: PMC9132751 DOI: 10.1007/s00247-022-05393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022]
Abstract
The two primary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are acute coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome (MIS-C). While most pediatric cases of acute COVID-19 disease are mild or asymptomatic, some children are at risk for developing severe pneumonia. In MIS-C, children present a few weeks after SARS-CoV-2 exposure with a febrile illness that can rapidly progress to shock and multiorgan dysfunction. In both diseases, the clinical and laboratory findings can be nonspecific and present a diagnostic challenge. Thoracic imaging is commonly obtained to assist with initial workup, assessment of disease progression, and guidance of therapy. This paper reviews the radiologic findings of acute COVID-19 pneumonia and MIS-C, highlights the key distinctions between the entities, and summarizes our understanding of the role of imaging in managing SARS-CoV-2-related illness in children.
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25
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Fadgyas B, Garai GI, Schnur J, Kiss VI, Vass V, Mátyus E, Balázs G, Cserni T. COVID-19-Related Intestinal Ischemia in A 7-Year Old Boy. European J Pediatr Surg Rep 2022; 10:e107-e110. [PMID: 35992308 PMCID: PMC9381359 DOI: 10.1055/s-0042-1755721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 01/18/2022] [Indexed: 10/26/2022] Open
Abstract
AbstractSevere abdominal pain and vomiting are common symptoms in children with pediatric multisystem inflammatory syndrome (PIMS). Mesenteric lymphadenitis and aseptic peritonitis are predominantly reported in cases where acute surgical abdomen was suspected and laparotomy was performed at the early stage of the pandemic. These reports generally discouraged surgeons to perform exploration in COVID-19-related cases and medical management was prioritized. Only a few COVID-19-specific surgical cases with intestinal ischemia were published. Here, we report another case of COVID-19-related intestinal ischemia complicated with Meckel's diverticulitis in a non-immunocompromised child who clearly required surgical intervention. In our case, the combination of COVID-19-related vasculitis and low blood pressure episodes may have contributed to this severe outcome.
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Affiliation(s)
- Balázs Fadgyas
- Department of Surgery and Traumatology, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Gábor István Garai
- Department of Surgery and Traumatology, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - János Schnur
- Department of Anaesthesia & Intensive Care, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Viktória Irén Kiss
- Department of Anaesthesia & Intensive Care, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Viktória Vass
- Department of Pathology, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Enikő Mátyus
- Center of MRI and CT Diagnostics, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - György Balázs
- Center of MRI and CT Diagnostics, Heim Pál National Institute of Paediatrics, Budapest, Hungary
| | - Tamas Cserni
- Department of Pediatric Surgery, Josa Andras Hospital Nyíregyháza, Teaching Hospital of Medical Health Science Centre University of Debrecen, Nyíregyháza, Hungary
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26
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Trevisan M, Amaddeo A, Taddio A, Boscarelli A, Barbi E, Cozzi G. Case Report: Simil-Appendicitis Presentation May Precede Cardiac Involvement in MIS-C Patient. Front Pediatr 2022; 10:832391. [PMID: 35321006 PMCID: PMC8936065 DOI: 10.3389/fped.2022.832391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity characterized by a systemic hyperinflammation triggered by SARS-CoV-2 infection in children and adolescents. This condition could potentially involve all organs with main complications concerning cardiovascular system. Despite up to 90% of patients complain gastrointestinal symptoms (nausea, vomit, and diarrhea), a presentation mimicking acute appendicitis has rarely been reported, and can be the presenting feature of the disease, potentially leading to misdiagnosis and delayed treatment. CASE DESCRIPTION A 15-year-old boy presented to the Emergency Department for a 2-day history of fever, vomiting, and mild abdominal pain. One month before, the patient complained ageusia and anosmia while his mother tested positive for Sars-CoV2 nasopharyngeal swab. At admission, laboratory tests showed leukocytosis with lymphopenia and elevation of inflammatory markers, while cardiac enzymes, electrocardiogram and echocardiography were unremarkable. An abdominal ultrasound displayed a thickening of terminal ileus and cecum with ascites. Because of the worsening abdominal pain and a physical examination suggestive of acute appendicitis, a laparoscopy was performed but no surgical condition was found. After surgery, fever and generalized malaise persisted, so a cardiac evaluation was repeated, showing a relevant increase in inflammatory markers and cardiac enzymes. Electrocardiogram demonstrated a QTc prolongation with mild decrease in left ventricular ejection fraction at echocardiogram. A MIS-C was diagnosed and intravenous immunoglobulin along with a steroid treatment started. After 36 h, the patient presented a complete clinical recovery with fever cessation. Cardiac anomalies normalized in 3 weeks. CONCLUSION MIS-C has been defined as a systemic inflammation, involving at least two organs, after a previous SARS-CoV2 infection in children and adolescents. Physicians should be aware that while gastrointestinal manifestations are common, a pseudo appendicitis presentation may also occur, leading to misdiagnosis and delayed treatment. This report suggests that in patients with symptoms suggestive of an acute appendicitis, the presence of lymphopenia, hypoalbuminemia and ultrasound images of terminal ileus inflammation, should raise the suspect for MIS-C even without initial overt signs of cardiac involvement.
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Affiliation(s)
- Matteo Trevisan
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Alessandro Boscarelli
- Institute for Maternal and Child Health Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
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27
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Fabi M, Vasuri F, Guida F, Rocca A, Lima M, D'Errico A, Lanari M. Case report: Histological findings of peri-appendicitis in three children with SARS-CoV-2 - related multisystem inflammatory syndrome: A mark for systemic inflammation? Front Pediatr 2022; 10:975940. [PMID: 36467465 PMCID: PMC9714539 DOI: 10.3389/fped.2022.975940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition that can potentially develop after SARS-CoV-2 infection in children. Gastrointestinal manifestation in MIS-C can mimic acute abdomen, potentially leading to unnecessary surgical treatment. Immune-mediated mechanisms seem to be a determining factor in its pathogenesis, and histological studies can help to shed light on this aspect. We describe three cases of children diagnosed with MIS-C that underwent appendectomy. METHODS We retrospectively collected the clinical features and histological findings of three previously healthy children who underwent appendectomy for clinical suspicion of acute appendicitis but were later diagnosed with MIS-C. FINDINGS The three children presented with prominent abdominal manifestations and fever leading to the suspicion of acute abdomen. Histological findings showed transmural and perivascular inflammation. Notably, CD68+ macrophages were predominant in the child with milder abdominal symptoms without cardiac injury, while CD3+ lymphocytes in the patient presented with more severe abdominal pain and cardiovascular involvement at admission. INTERPRETATION Gastrointestinal symptoms of children with MIS-C improve after proper immunomodulatory therapy, conversely showing inadequate response to surgical appendectomy. Histological findings revealed different inflammatory cell infiltration that primarily involved perivisceral fat and vessels, and subsequently mucosal tissue, in contrast to other forms of acute appendicitis. Our findings suggest that this kind of peri-appendicitis in MIS-C could represent a focal sign of systemic inflammation, with different histological patterns compared to other forms of acute appendicitis.
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Affiliation(s)
- Marianna Fabi
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fiorentina Guida
- Speciality School of Pediatrics, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessandro Rocca
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mario Lima
- Division of Pediatric Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonietta D'Errico
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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28
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Multisystem Inflammatory Syndrome in Children Presenting as Subacute Intestinal Obstruction. Indian J Pediatr 2022; 89:91. [PMID: 34487303 PMCID: PMC8420140 DOI: 10.1007/s12098-021-03949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
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29
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Necrotizing Enterocolitis in a 34-Week Premature Infant with COVID-19. Case Rep Infect Dis 2021; 2021:1442447. [PMID: 34956682 PMCID: PMC8703157 DOI: 10.1155/2021/1442447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral respiratory infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). While SARS-CoV-2 is a leading cause of morbidity and mortality in older adults, COVID-19 also affects newborn infants in nurseries and the Neonatal Intensive Care Units (NICUs). The majority of infected neonates are believed to acquire SARS-CoV-2 by horizontal transmission, and most of them have asymptomatic or mild symptomatic infections. In rare cases, infants with COVID-19 may have severe complications resulting in death. We report a case of COVID-19 in a premature neonate born at 34 weeks gestational age who presented with hypothermia and respiratory distress and subsequently developed clinical and radiological signs of necrotizing enterocolitis (NEC). The neonate received medical management, including antibiotics, suspension of gastric feeds, and intensive NICU support. The neonate's clinical condition improved without surgical intervention, and after 10 days of antibiotics and gradual reestablishment of gastric feeds, patient health condition returned to normal, and weeks later, he was discharged home. COVID-19 in infants is frequently asymptomatic or associated with mild disease, and in rare cases, it may be associated with severe gastrointestinal complications including NEC.
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30
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Gandhi VV, Hegde A, Kavade S, Gore S. Primary Peritonitis with Subacute Intestinal Obstruction: An Unusual Presentation of Multisystem Inflammatory Syndrome in Children. J Indian Assoc Pediatr Surg 2021; 26:468-469. [PMID: 34912156 PMCID: PMC8637988 DOI: 10.4103/jiaps.jiaps_108_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Adarsh Hegde
- Pediatric Surgeon, Dr. DY Patil Medical College Hospital and Research Center, Pune, Maharashtra, India
| | - Sandeep Kavade
- Pediatric consultant, Department of Pediatrics, VMCC Hospital, Pune, Maharashtra, India
| | - Shankar Gore
- Pediatric consultant, Department of Pediatrics, VMCC Hospital, Pune, Maharashtra, India
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31
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Gün E, Kendirli T, Botan E, Demir B, Ergün E, Özdemir H, Fitoz ÖS, Ciftci E, Tutar E. Acute Abdomen—A Clinical Presentation of MIS-C in Children. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1739394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study was to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis.
Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included.
Results Seven patients with a median age of 12.5 (interquartile range 10.5–13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also had an acute abdomen. One patient had malignant hyperthermia during induction of anesthesia, so surgery was postponed and medical management was commenced. The clinical picture regressed with immunomodulation. All patients were treated with intravenous immunoglobulin and steroids. Four patients with acute abdomens improved with immunomodulation, and surgery was not needed.
Conclusion MIS-C may present with an acute abdomen. Immunomodulation should be considered instead of surgery if the clinical course is not complicated.
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Affiliation(s)
- Emrah Gün
- Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
| | - Edin Botan
- Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
| | - Berrin Demir
- Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ergun Ergün
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Suat Fitoz
- Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
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32
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Abstract
Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.
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Affiliation(s)
- Richard Taylor
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA
| | - Daniel Mallon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2010, Cincinnati, OH 45229, USA.
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33
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Kanmaniraja D, Kurian J, Holder J, Gunther MS, Chernyak V, Hsu K, Lee J, Mcclelland A, Slasky SE, Le J, Ricci ZJ. Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children. Clin Imaging 2021; 80:88-110. [PMID: 34298343 PMCID: PMC8223038 DOI: 10.1016/j.clinimag.2021.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/23/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID -19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world, resulting in severe morbidity, mortality and economic hardship, and altering the landscape of healthcare forever. Although primarily a pulmonary illness, it can affect multiple organ systems throughout the body, sometimes with devastating complications and long-term sequelae. As we move into the second year of this pandemic, a better understanding of the pathophysiology of the virus and the varied imaging findings of COVID-19 in the involved organs is crucial to better manage this complex multi-organ disease and to help improve overall survival. This manuscript provides a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19 with the exception of unique cardiothoracic features associated with multisystem inflammatory syndrome in children (MIS-C). In Part I, extra-thoracic manifestations of COVID-19 in the abdomen in adults and features of MIS-C will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
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Affiliation(s)
- Devaraju Kanmaniraja
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Jessica Kurian
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Justin Holder
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Molly Somberg Gunther
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Kevin Hsu
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Jimmy Lee
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Andrew Mcclelland
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Shira E Slasky
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America
| | - Jenna Le
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
| | - Zina J Ricci
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States of America.
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Ardila Gómez IJ, López PP, Duque DC, García DMS, Romero AF, Vega MRV, Ramos Castañeda JA. Abdominal manifestation of multisystemic inflammatory syndrome in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 74:102042. [PMID: 34545321 PMCID: PMC8444470 DOI: 10.1016/j.epsc.2021.102042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/29/2022] Open
Abstract
Summary Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury. Method ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management. Results The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis. Conclusions patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.
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Affiliation(s)
- Iván José Ardila Gómez
- Pediatric Critical Care, Colombia.,Clínica Uros, Neiva, Huila, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Pilar Pérez López
- Pediatric Rheumatology, Colombia.,Clínica Uros, Neiva, Huila, Colombia.,Clínica Medilaser, Neiva, Huila, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Darling Carvajal Duque
- Pediatric Critical Care, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Doris Martha Salgado García
- Pediatric Bioethicist, Colombia.,Pediatric Infectious Diseases, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Andres Felipe Romero
- Pediatric Infectious Diseases, Colombia.,Clínica Uros, Neiva, Huila, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Martha Rocío Vega Vega
- Pediatric Bioethicist, Colombia.,Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.,Professor at Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Jorge Andres Ramos Castañeda
- Professor at Universidad Surcolombiana, Neiva, Huila, Colombia.,MSc Clinical Epidemiology, PhD Public Health, Universidad Antonio Nariño, Neiva, Huila, Colombia
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Abstract
Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.
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Abstract
PURPOSE OF REVIEW To review diagnosis, clinical characteristics and treatment of multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RECENT FINDINGS MIS-C emerged in spring 2020 as a hyperinflammatory syndrome following SARS-CoV-2 exposure in children. Despite growing awareness of MIS-C, diagnosis remains challenging due to the range of phenotypes and severity. Fever accompanied by shock, cardiac dysfunction, gastrointestinal symptoms, or mucocutaneous signs suggestive of Kawasaki disease, especially in the presence of known or suspected coronavirus disease 2019 exposure, should trigger consideration of MIS-C. However, clinical presentations are highly varied and may overlap with other infectious diseases. Clinicians must maintain a high index of suspicion for MIS-C and be aware that patients may develop coronary artery aneurysms and myocarditis even with few or no Kawasaki disease symptoms. More precise diagnostic criteria and specific biomarkers are needed to aid diagnosis. Intravenous immunoglobulin (IVIG) is first-line therapy, and steroids should be considered as initial adjunctive treatment for patients with severe manifestations or other risk factors. Prompt treatment is essential, as patients may worsen acutely, though overall prognosis is reassuring. SUMMARY MIS-C associated with SARS-CoV-2 has varied clinical manifestations. Clinicians must be aware of the common presentation and potential for decompensation and cardiac sequalae to guide appropriate evaluation and treatment.
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Affiliation(s)
- Jordan E Roberts
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Singh P, Singh SP, Verma AK, Raju SN, Parihar A. A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients. Visc Med 2021; 26:1-12. [PMID: 34580634 PMCID: PMC8450847 DOI: 10.1159/000518473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate key imaging manifestations of COVID-19 on abdominal imaging by utilizing a comprehensive review of the published literature. METHOD A systematic literature search from PubMed, Google Scholar, and Scopus was performed for studies mentioning abdominal imaging findings in COVID-19 patients. Studies published from inception to 15 March 2021 were included. RESULTS A total of 116 studies comprising 1,198 patients were included. Abdominal pain was the most common indication for abdominal imaging in 50.2% of the patients. No abnormality was seen in 48.1% of abdominopelvic computed tomography scans. Segmental bowel wall thickening (14.7%) was the most common imaging abnormality, followed by bowel ischemia (7.1%), solid organ infarction (6.7%), vessel thrombosis (6.7%), and fluid-filled colon (6.2%). Other relevant findings were dilated air-filled bowel, pancreatitis, pneumatosis/portal venous gas, bowel perforation, and appendicitis. Other than abdominal findings, COVID-19-related basal lung changes were incidentally detected in many studies. Moreover, the presence of bowel imaging findings was positively correlated with the clinical severity of COVID-19 infection. CONCLUSION This review describes the abdominal imaging findings in COVID-19 patients. This is pertinent for the early diagnosis of COVID-19 in patients presenting solely with abdominal symptoms as well as in identifying abdominal complications in a known case of COVID-19.
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Affiliation(s)
- Priya Singh
- Radiodiagnosis, King George Medical University, Lucknow, India
| | - Surya Pratap Singh
- Cardiovascular Radiology and Endovascular Intervention, All India Institute of Medical Science, New Delhi, India
| | | | - Sreenivasa Narayana Raju
- Cardiovascular Radiology and Endovascular Intervention, All India Institute of Medical Science, New Delhi, India
| | - Anit Parihar
- Radiodiagnosis, King George Medical University, Lucknow, India
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Hennon TR, Yu KOA, Penque MD, Abdul-Aziz R, Chang AC, McGreevy MB, Pastore JV, Prout AJ, Schaefer BA, Alibrahim OS, Gomez-Duarte OG, Hicar MD. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves. PROGRESS IN PEDIATRIC CARDIOLOGY 2021; 62:101407. [PMID: 34121829 PMCID: PMC8179839 DOI: 10.1016/j.ppedcard.2021.101407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023]
Abstract
Multisystem inflammatory syndrome of children (MIS-C) continues to be a highly concerning diagnosis in those recently infected with SARS-CoV-2. The diagnosis of MIS-C cases will likely become even more challenging as vaccine uptake and natural immunity in previously infected persons leads to lower circulating rates of SARS-CoV-2 infection and will make cases sporadic. Febrile children presenting with cardiac dysfunction, symptoms overlapping Kawasaki disease or significant gastrointestinal complaints warrant a thorough screen in emergency departments, urgent care centers, and outpatient pediatric or family medicine practices. An increased index of suspicion and discussion regarding higher level of care (transferring to pediatric tertiary care centers or to intensive care) continues to be recommended. Herein we outline a broad approach with a multidisciplinary team for those meeting the case definition and believe such an approach is crucial for successful outcomes.
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Key Words
- AP, approved
- ASO, anti-streptolysin O
- BNP, brain-natriuretic peptide
- CDC, Center for Disease Control
- COVID-19
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- CXCL10, C-X-C-motif chemokine ligand 10
- DCBLD2, Discoidin, CUB and LCCL domain-containing protein 2
- E, envelope protein
- E.U., European Union
- ECMO, extracorporeal membrane oxygenation
- EKG, electrocardiogram
- EM, emergency use
- FDA, US Food and Drug Authority
- Fever
- GI, gastrointestinal
- IL, interleukin
- IVIG, intravenous immunoglobulin G
- Inflammation
- KD, Kawasaki disease
- LDH, lactate dehydrogenase
- LFTs, liver function tests
- M, membrane protein
- MIS-C
- MIS-C, Multisystem Inflammatory Syndrome in Children
- Mpred, methylprednisolone
- NP, Nucleoprotein
- PCR, polymerase chain reaction
- PT, prothrombin time
- PTT, partial thromboplastin time
- Pediatric
- RBD, receptor binding domain
- SARS-CoV-2
- TE, thromboembolic events
- TNF, tumor necrosis factor
- TWEAK, TNF-like weak inducer of apoptosis
- U.S., United States of America
- VA, veno-arterial
- VLPs, virus-like particles
- VTE, venous thromboembolic events
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Affiliation(s)
- Teresa R Hennon
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Karl O A Yu
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Michelle D Penque
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Rabheh Abdul-Aziz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Arthur C Chang
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Megan B McGreevy
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - John V Pastore
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Andrew J Prout
- Wayne State University School of Medicine, Detroit, MI, United States of America.,Children's Hospital of Michigan, Detroit, MI, United States of America
| | - Beverly A Schaefer
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Omar S Alibrahim
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Oscar G Gomez-Duarte
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Mark D Hicar
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
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Intestinal Abnormalities in Patients With SARS-CoV-2 Infection: Histopathologic Changes Reflect Mechanisms of Disease. Am J Surg Pathol 2021; 46:89-96. [PMID: 34081038 DOI: 10.1097/pas.0000000000001755] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 20% of patients with symptomatic syndrome-associated coronavirus-2 (SARS-CoV-2) infection have gastrointestinal bleeding and/or diarrhea. Most are managed without endoscopic evaluation because the risk of practitioner infection outweighs the value of biopsy analysis unless symptoms are life-threatening. As a result, much of what is known about the gastrointestinal manifestations of coronavirus disease-2019 (COVID-19) has been gleaned from surgical and autopsy cases that suffer from extensive ischemic injury and/or poor preservation. There are no detailed reports describing any other gastrointestinal effects of SARS-CoV-2 even though >3,000,000 people have died from COVID-19 worldwide. The purpose of this study is to report the intestinal findings related to SARS-CoV-2 infection by way of a small case series including one with evidence of direct viral cytopathic effect and 2 with secondary injury attributed to viral infection. Infection can be confirmed by immunohistochemical stains directed against SARS-CoV-2 spike protein, in situ hybridization for spike protein-encoding RNA, and ultrastructural visualization of viruses within the epithelium. It induces cytoplasmic blebs and tufted epithelial cells without inflammation and may not cause symptoms. In contrast, SARS-CoV-2 infection can cause gastrointestinal symptoms after the virus is no longer detected, reflecting systemic activation of cytokine and complement cascades rather than direct viral injury. Reversible mucosal ischemia features microvascular injury with hemorrhage, small vessel thrombosis, and platelet-rich thrombi. Systemic cytokine elaboration and dysbiosis likely explain epithelial cell injury that accompanies diarrheal symptoms. These observations are consistent with clinical and in vitro data and contribute to our understanding of the protean manifestations of COVID-19.
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40
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Fresh Per Rectal Bleeding in Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS). Indian J Pediatr 2021; 88:607. [PMID: 33745112 PMCID: PMC7982079 DOI: 10.1007/s12098-021-03728-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/05/2021] [Indexed: 11/06/2022]
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41
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Calcagno E, Sogunro O, Nepal P, Assaker R, Sapire J. COVID-19 induced mesenteric venous infarction. Radiol Case Rep 2021; 16:1999-2002. [PMID: 33995746 PMCID: PMC8112386 DOI: 10.1016/j.radcr.2021.04.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
We present a rare case of mesenteric venous infarction in a 36-year-old man due to coronavirus disease-19 (COVID-19). Although COVID-19 usually presents with respiratory disease, multi-system manifestations are increasingly reported. Coagulopathy manifestations are also reported on imaging, including in vascular thrombosis, embolus, and organ infarction. Because the clinical variables poorly predict or suspect coagulopathy and its complications, it is important to be aware of imaging manifestations of coagulopathy complications of COVID-19.
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Affiliation(s)
- Emma Calcagno
- Frank H Netter MD School of Medicine, Quinnipiac University, 370 Bassett Rd, North Haven, CT, 06473, USA
| | - Olutayo Sogunro
- St. Vincent's Medical Center, 2800 Main St, Bridgeport, CT 06606, USA
| | - Pankaj Nepal
- St. Vincent's Medical Center, 2800 Main St, Bridgeport, CT 06606, USA
| | - Richard Assaker
- St. Vincent's Medical Center, 2800 Main St, Bridgeport, CT 06606, USA
| | - Joshua Sapire
- St. Vincent's Medical Center, 2800 Main St, Bridgeport, CT 06606, USA
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42
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Duarte-Neto AN, Caldini EG, Gomes-Gouvêa MS, Kanamura CT, de Almeida Monteiro RA, Ferranti JF, Ventura AMC, Regalio FA, Fiorenzano DM, Gibelli MABC, Carvalho WBD, Leal GN, Pinho JRR, Delgado AF, Carneiro-Sampaio M, Mauad T, Ferraz da Silva LF, Saldiva PHN, Dolhnikoff M. An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C. EClinicalMedicine 2021; 35:100850. [PMID: 33937731 PMCID: PMC8072136 DOI: 10.1016/j.eclinm.2021.100850] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated mechanisms or the direct effect of SARS-CoV-2 on tissues. We describe the autopsy findings in five cases of paediatric COVID-19 and provide mechanistic insight into the mechanisms involved in the pathogenesis of the disease. METHODS Children and adolescents who died with COVID-19 between March 18 and August 15, 2020 were autopsied with a minimally invasive method. Tissue samples from all vital organs were analysed by histology, electron microscopy (EM), reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). FINDINGS Five patients were included, one male and four female, aged 7 months to 15 years. Two patients had severe diseases before SARS-CoV-2 infection: adrenal carcinoma and Edwards syndrome. Three patients were previously healthy and had multisystem inflammatory syndrome in children (MIS-C) with distinct clinical presentations: myocarditis, colitis, and acute encephalopathy with status epilepticus. Autopsy findings varied amongst patients and included mild to severe COVID-19 pneumonia, pulmonary microthrombosis, cerebral oedema with reactive gliosis, myocarditis, intestinal inflammation, and haemophagocytosis. SARS-CoV-2 was detected in all patients in lungs, heart and kidneys by at least one method (RT-PCR, IHC or EM), and in endothelial cells from heart and brain in two patients with MIS-C (IHC). In addition, we show for the first time the presence of SARS-CoV-2 in the brain tissue of a child with MIS-C with acute encephalopathy, and in the intestinal tissue of a child with acute colitis. Interpretation: SARS-CoV-2 can infect several cell and tissue types in paediatric patients, and the target organ for the clinical manifestation varies amongst individuals. Two major patterns of severe COVID-19 were observed: a primarily pulmonary disease, with severe acute respiratory disease and diffuse alveolar damage, or a multisystem inflammatory syndrome with the involvement of several organs. The presence of SARS-CoV-2 in several organs, associated with cellular ultrastructural changes, reinforces the hypothesis that a direct effect of SARS-CoV-2 on tissues is involved in the pathogenesis of MIS-C. FUNDING Fundação de Amparo à Pesquisa do Estado de São Paulo, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Bill and Melinda Gates Foundation.
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Affiliation(s)
- Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Instituto Adolfo Lutz. Av. Dr. Arnaldo, 351, 01246-000 São Paulo, SP, Brasil
| | - Elia Garcia Caldini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Michele Soares Gomes-Gouvêa
- Departamento de Gastroenterologia, LIM 07, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 500, 05403-000 São Paulo, SP, Brasil
| | | | | | - Juliana Ferreira Ferranti
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Andrea Maria Cordeiro Ventura
- Unidade de Terapia Intensiva Pediátrica, Departamento de Pediatria, Hospital Universitário da Universidade de São Paulo. Av. Prof. Lineu Prestes, 2565, 05508-000 São Paulo, SP, Brasil
| | - Fabiane Aliotti Regalio
- Divisão de Anestesia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Av. Dr Enéas de Carvalho Aguiar, 255, 01246-000 São Paulo, SP, Brasil
| | - Daniela Matos Fiorenzano
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Maria Augusta Bento Cicaroni Gibelli
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Werther Brunow de Carvalho
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Gabriela Nunes Leal
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - João Renato Rebello Pinho
- Departamento de Gastroenterologia, LIM 07, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 500, 05403-000 São Paulo, SP, Brasil
| | - Artur Figueiredo Delgado
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Magda Carneiro-Sampaio
- Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 647, 05403-000 São Paulo, SP, Brasil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo. Av Dr Enéas de Carvalho Aguiar, 250, 05403-000 São Paulo, SP, Brasil
| | - Paulo Hilario Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Arnaldo, 455, 01246-903 São Paulo, SP, Brasil
- Corresponding author at: Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia. Av. Dr. Arnaldo, 455, sala 1155 – Cerqueira Cesar, Sao Paulo, SP 01246-903, Brasil.
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43
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Sweeny KF, Zhang YJ, Crume B, Martz CA, Blessing MM, Kahn SA. Inflammatory Bowel Disease Presenting With Concurrent COVID-19 Multisystem Inflammatory Syndrome. Pediatrics 2021; 147:peds.2020-027763. [PMID: 33414238 PMCID: PMC8015148 DOI: 10.1542/peds.2020-027763] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/28/2022] Open
Abstract
Coronavirus disease 2019 is associated with a postinfectious multisystem inflammatory syndrome in children (MIS-C). This syndrome is marked by cytokine storm and multiorgan dysfunction, often affecting the gastrointestinal tract, the heart, and the hematopoietic system. We describe the case of a 16-year-old boy with an initial presentation of severe inflammatory bowel disease and concurrent MIS-C. He presented with abdominal pain, diarrhea, and hematochezia and met criteria for the systemic inflammatory response syndrome. Laboratory inflammatory profiling revealed markedly elevated ferritin, D-dimer, C-reactive protein, soluble interleukin 2, and interleukin 6 levels. Endoscopy and colonoscopy revealed severe active gastroduodenitis, patchy colitis, and a normal-appearing terminal ileum. The patient was treated with a combination of steroids, intravenous immunoglobulin, and infliximab, and his symptoms slowly resolved over a 3-week period. In this case, we describe coincident MIS-C with a remarkably severe and difficult-to-treat initial presentation of inflammatory bowel disease and highlight the need to investigate the effect of coronavirus disease 2019 and MIS-C on inflammatory disorders.
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Affiliation(s)
- Katherine F. Sweeny
- Division of Gastroenterology, Hepatology and Nutrition and,Contributed equally as co-first authors
| | - Yanjia J. Zhang
- Division of Gastroenterology, Hepatology and Nutrition and,Contributed equally as co-first authors
| | | | | | | | - Stacy A. Kahn
- Division of Gastroenterology, Hepatology and Nutrition and
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Ashktorab Y, Brim A, Pizuorno A, Gayam V, Nikdel S, Brim H. COVID-19 Pediatric Patients: Gastrointestinal Symptoms, Presentations, and Disparities by Race/Ethnicity in a Large, Multicenter US Study. Gastroenterology 2021; 160:1842-1844. [PMID: 33421514 PMCID: PMC7787077 DOI: 10.1053/j.gastro.2020.12.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Yusuf Ashktorab
- Department of Medicine, Howard University College of Medicine, Washington DC
| | - Anas Brim
- Department of Medicine, Howard University College of Medicine, Washington DC
| | - Antonio Pizuorno
- Faculty of Medicine, School of Medicine, La Universidad del Zulia, Maracaibo, Zulia state, Venezuela
| | - Vijay Gayam
- Department of Medicine, SUNY Downstate University Hospital, New York
| | - Sahar Nikdel
- Department of Medicine, Howard University College of Medicine, Washington DC
| | - Hassan Brim
- Department of Medicine, Howard University College of Medicine, Washington DC.
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Josyabhatla R, Kamdar AA, Armbrister SA, Daniel R, Boukas K, Smith KG, Van Arsdall MR, Kakarala K, Flores AR, Wanger A, Liu Y, Rhoads JM. Recognizing a MIS-Chievous Cause of Acute Viral Gastroenteritis. Front Pediatr 2021; 9:748368. [PMID: 34778138 PMCID: PMC8588082 DOI: 10.3389/fped.2021.748368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
Historically, children evaluated for vomiting and diarrhea secondary to viral enteritis have symptoms lasting 2-4 days and respond to supportive care, including oral rehydration and anti-emetics if required. Recently, within a 14-day timespan, we encountered three children with severe diarrhea who rapidly became dehydrated and went into hypotensive shock. Although SARS-CoV-2 molecular tests were negative by nasopharyngeal swab, all were later found to have MIS-C. This small case series underscores features reported in previous larger studies and emphasizes the rapid clinical evolution of this condition. We highlight the importance of early recognition of cardinal laboratory findings characteristic of MIS-C (i.e., lymphopenia, markedly elevated acute phase reactants, and hypoalbuminemia). We also show serologic evidence that the pathophysiological mechanism of SARS-CoV-2 related diarrhea may differ from other causes of dehydrating vomiting and diarrhea, with no serologic evidence of villus cell injury.
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Affiliation(s)
- Rohit Josyabhatla
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Ankur A Kamdar
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Shabba A Armbrister
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Rhea Daniel
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Konstantinos Boukas
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Critical Care Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Keely G Smith
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Melissa R Van Arsdall
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Kokila Kakarala
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anthony R Flores
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Audrey Wanger
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yuying Liu
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jon Marc Rhoads
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
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Abdel-Haq N, Asmar BI, Deza Leon MP, McGrath EJ, Arora HS, Cashen K, Tilford B, Charaf Eddine A, Sethuraman U, Ang JY. SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment. Eur J Pediatr 2021; 180:1581-1591. [PMID: 33452570 PMCID: PMC7810600 DOI: 10.1007/s00431-021-03935-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children's Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)-like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered.Conclusion: MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) manifestations include fever, gastrointestinal symptoms, shock, and occasional features of Kawasaki disease (KD). • Treatment includes immunomodulatory agents, most commonly IVIG and corticosteroids. What is New: • Spectrum of MIS-C varies from mild to severe inflammation and coronary artery dilatation occurred in 5/22 (23%) critically ill patients. • IVIG and infliximab therapy were associated with a favorable outcome including resolution of coronary dilatation; only 2/33 received corticosteroids.
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Affiliation(s)
- Nahed Abdel-Haq
- Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. .,Wayne State University, Detroit, MI, USA. .,Central Michigan University, Mount Pleasant, MI, USA.
| | - Basim I. Asmar
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Maria P. Deza Leon
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA
| | - Eric J. McGrath
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA
| | - Harbir S. Arora
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Katherine Cashen
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Bradley Tilford
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Ahmad Charaf Eddine
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Usha Sethuraman
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
| | - Jocelyn Y. Ang
- grid.414154.10000 0000 9144 1055Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 USA ,grid.254444.70000 0001 1456 7807Wayne State University, Detroit, MI USA ,grid.253856.f0000 0001 2113 4110Central Michigan University, Mount Pleasant, MI USA
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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