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. 2022 Apr 4:40:e2021046.
doi: 10.1590/1984-0462/2022/40/2021046. eCollection 2022.

Multisystem inflammatory syndrome in children: a case series

[Article in English, Portuguese]
Arianne Ditzel Gaspar  1 , Gabriela de Sio Puetter Kuzma  1 , Luana Amancio  1 , Idilla Floriani  1 , Vinicius Neves Bezerra  1 , Gabriela Cristina Bortolon  1 , Ana Paula Viana de Siqueira  1 , Maura Peruchi Machado  1 , Ana Cristina Dos Santos Machado  1 , Camila Faversani Camargo  1 , Paulo Ramos David João  1
Affiliations

Multisystem inflammatory syndrome in children: a case series

[Article in English, Portuguese]
Arianne Ditzel Gaspar et al. Rev Paul Pediatr. .

Abstract
in English, Portuguese

Objective: To describe a case series of multisystem inflammatory syndrome in children (MIS-C) in a pediatric tertiary hospital.

Methods: Patients under the age of 18 years who met MIS-C criteria of the Brazilian Ministry of Health (MH) and/or the Royal College of Paediatrics and Child Health (RCPCH) were included. A retrospective analysis was carried out by reviewing medical records and complementary exams.

Results: Six pediatric patients with mean age of 126 months were admitted with fever associated with multisystem involvement: all of them had abdominal pain and diarrhea and two underwent appendectomy; 100% had coagulopathy and increased inflammatory markers; 83% had cardiovascular impairment and 60% required vasoactive drugs; 83% had mucocutaneous symptoms and 50% required ventilatory support by invasive mechanical ventilation or non-invasive ventilation. One patient showed coronary artery dilation on echocardiogram. All patients received empiric antibiotic therapies. SARS-CoV-2 IgG testing was positive in five patients. Treatment was performed after excluding infectious causes: five patients (83%) received intravenous immunoglobulin, five patients (83%) pulse methylprednisolone therapy and one (16%) Tocilizumab. One patient died. The average length of stay in Pediatric Intensive Care Unit (PICU) was seven days.

Conclusions: These cases are added to the literature in construction of this emerging condition. Early diagnosis should be considered due to its potential severity.

Objetivo: Descrever uma série de casos de síndrome inflamatória multissistêmica pediátrica (SIM-P) atendidos em um hospital terciário pediátrico.

Métodos: Foram incluídos pacientes com idade menor que 18 anos que preenchessem os critérios de SIM-P do Ministério da Saúde (MS) e/ou do Royal College of Paediatrics and Child Health (RCPCH). Realizou-se análise retrospectiva por revisão de prontuário médico e de exames complementares.

Resultados: Seis pacientes pediátricos com idade média de 126 meses, admitidos com quadro de febre associada a acometimento multissistêmico: todos apresentavam dor abdominal e diarreia e dois foram submetidos a apendicectomia; 100% apresentava coagulopatia e aumento das provas de atividade inflamatória; 83% apresentou comprometimento cardiovascular e 66% necessitou de drogas vasoativas; 83% apresentou sintomas mucocutâneos e 50% necessitou de suporte ventilatório por meio de ventilação mecânica invasiva ou não invasiva. Um paciente apresentou dilatação coronariana na ecocardiografia. Todos receberam antibioticoterapia empírica. Foi detectada sorologia de imunoglobina G positiva para SARS-CoV-2 em cinco pacientes. O tratamento foi realizado após a exclusão de causas infecciosas: imunoglobulina endovenosa em cinco pacientes (83%), pulsoterapia com metilprednisolona em cinco (83%) e Tocilizumabe em um (16%). Um paciente evoluiu para óbito. O tempo médio de internação em Unidade de Terapia Intensiva (UTI) foi de sete dias.

Conclusões: Somam-se esses casos à literatura em construção para essa condição emergente. O diagnóstico deve ser considerado precocemente por seu potencial gravidade.

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Conflict of interest statement

Conflict of interests

The authors declare no conflict of interest.

References

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