Clinical profile and outcomes of multisystem inflammatory syndrome in children (MIS-C): Hospital-based prospective observational study from a tertiary care hospital in South India

AIM

To study the clinical profile and outcomes in children with multisystem inflammatory syndrome in children (MIS-C).

METHODS

Children aged 1 month to 15 years presenting with MIS-C (May 2020 to November 2021) were enrolled. Clinical, laboratory, echocardiography parameters and outcomes were analysed.

RESULTS

Eighty-one children (median age 60 months (24-100)) were enrolled. Median duration of fever was 5 days (3-7). Twenty-nine (35.8%) had shock (severe MIS-C) including 23 (28.3%) requiring inotropes (median duration = 25 h (7.5-33)). Ten required mechanical ventilation, 12 had acute kidney injury and 1 child died. Left ventricular (LV) dysfunction was seen in 38 (46.9%), 16 (19.7%) had coronary artery abnormalities (CAA) and 13 (20%) had macrophage activation syndrome. Sixty-one (75.3%) were SARS CoV-2 positive (10 by RT-PCR and 51 by serology). Sixty-eight (83.9%) received immunomodulators. Younger age was significantly associated with CAA (P value = 0.05). Older age, LV dysfunction, SARS CoV-2 positivity, low platelet count and elevated serum ferritin were significantly associated with severe MIS-C (univariate analysis). Younger age was an independent predictor of CAA (P = 0.05); older age (P = 0.043) and low platelet count (P = 0.032) were independent predictors of severe MIS-C (multivariate logistic regression analysis).

CONCLUSION

Our patients had diverse clinical manifestations with a good outcome. Younger age was significantly associated with CAA. Older age, LV dysfunction, low platelet count and elevated serum ferritin were significantly associated with severe MIS-C. Younger age is an independent predictor of CAA. Older age and low platelet count are independent predictors of severe MIS-C.

An uncommon cause of spontaneous pneumothorax in a febrile infant: Atypical Kawasaki disease

Kawasaki disease after respiratory viral infections is often observed but following Human Metapneumovirus infection (HMPV) is uncommon. Pulmonary presentation of Kawasaki disease without its classical features, though uncommon, can present as bronchopneumonia refractory to routine supportive care and antibiotics treatment. Lung collapse and pneumothorax as a pulmonary presentation of atypical Kawasaki disease are described very infrequently. We report an infant with atypical Kawasaki disease secondary to Human Metapneumovirus infection where the above pulmonary complications were observed.