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. 2021 Mar 1;72(3):384-387.
doi: 10.1097/MPG.0000000000002953.

Features of Intestinal Disease Associated With COVID-Related Multisystem Inflammatory Syndrome in Children

Benjamin Sahn  1 , Ogechukwu P Eze  2 , Morris C Edelman  3 , Christina E Chougar  4 , Rebecca M Thomas  2 , Charles L Schleien  5 , Toba Weinstein  6
Affiliations

Features of Intestinal Disease Associated With COVID-Related Multisystem Inflammatory Syndrome in Children

Benjamin Sahn et al. J Pediatr Gastroenterol Nutr. .

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a recently identified syndrome that appears to be temporally associated with novel coronavirus 2019 infection. MIS-C presents with fever and evidence of systemic inflammation, which can manifest as cardiovascular, pulmonary, neurologic, and gastrointestinal (GI) system dysfunction. Presenting GI symptoms are seen in the majority, including abdominal pain, diarrhea, and vomiting. Any segment of the GI tract may be affected; however, inflammation in the ileum and colon predominates. Progressive bowel wall thickening can lead to luminal narrowing and obstruction. Most will have resolution of intestinal inflammation with medical therapies; however, in rare instances, surgical resection may be required.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Axial image from a computed tomography scan of the abdomen and pelvis with IV and oral contrast. The terminal ileum demonstrates marked circumferential thickening and luminal narrowing (arrows).
FIGURE 2
FIGURE 2
Gross and histology composite. (A) Ileocolic specimen. A 6 cm mass in the ileocolic pedicle (asterisk) and granular, thickened terminal ileum mucosa (arrow). (B) Transmural chronic inflammation. (C, D) Extensive venous microthrombi (arrows) present in mucosa, submucosa (pictured) and subserosa of terminal ileum. (E, F) Markedly inflamed mesentery with arterial transmural (asterisk) and subendothelial (arrows) lymphocytes, and endothelial fibrin deposition (arrowheads). (G) Inflamed arteries (asterisk) adjacent to unremarkable arteries (arrow). (H, I) Coalescent lymph nodes (ileocolic pedicle mass) with necrotizing lymphadenitis (asterisk). A = appendix; C = colon; M = mucosa; MP = muscularis propria; NL = necrotizing lymphadenitis; SM = submucosa; TI = terminal ileum.
See this image and copyright information in PMC

References

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Supplementary concepts