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10.1172/JCI141113

http://scihub22266oqcxt.onion/10.1172/JCI141113
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32701511!7598077!32701511
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suck abstract from ncbi


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pmid32701511      J+Clin+Invest 2020 ; 130 (11): 5942-5950
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  • Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflammatory syndrome in children #MMPMID32701511
  • Lee PY; Day-Lewis M; Henderson LA; Friedman KG; Lo J; Roberts JE; Lo MS; Platt CD; Chou J; Hoyt KJ; Baker AL; Banzon TM; Chang MH; Cohen E; de Ferranti SD; Dionne A; Habiballah S; Halyabar O; Hausmann JS; Hazen MM; Janssen E; Meidan E; Nelson RW; Nguyen AA; Sundel RP; Dedeoglu F; Nigrovic PA; Newburger JW; Son MBF
  • J Clin Invest 2020[Nov]; 130 (11): 5942-5950 PMID32701511show ga
  • BACKGROUNDPediatric SARS-CoV-2 infection can be complicated by a dangerous hyperinflammatory condition termed multisystem inflammatory syndrome in children (MIS-C). The clinical and immunologic spectrum of MIS-C and its relationship to other inflammatory conditions of childhood have not been studied in detail.METHODSWe retrospectively studied confirmed cases of MIS-C at our institution from March to June 2020. The clinical characteristics, laboratory studies, and treatment response were collected. Data were compared with historic cohorts of Kawasaki disease (KD) and macrophage activation syndrome (MAS).RESULTSTwenty-eight patients fulfilled the case definition of MIS-C. Median age at presentation was 9 years (range: 1 month to 17 years); 50% of patients had preexisting conditions. All patients had laboratory confirmation of SARS-CoV-2 infection. Seventeen patients (61%) required intensive care, including 7 patients (25%) who required inotrope support. Seven patients (25%) met criteria for complete or incomplete KD, and coronary abnormalities were found in 6 cases. Lymphopenia, thrombocytopenia, and elevation in inflammatory markers, D-dimer, B-type natriuretic peptide, IL-6, and IL-10 levels were common but not ubiquitous. Cytopenias distinguished MIS-C from KD and the degree of hyperferritinemia and pattern of cytokine production differed between MIS-C and MAS. Immunomodulatory therapy given to patients with MIS-C included intravenous immune globulin (IVIG) (71%), corticosteroids (61%), and anakinra (18%). Clinical and laboratory improvement were observed in all cases, including 6 cases that did not require immunomodulatory therapy. No mortality was recorded in this cohort.CONCLUSIONMIS-C encompasses a broad phenotypic spectrum with clinical and laboratory features distinct from KD and MAS.FUNDINGThis work was supported by the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases; the National Institute of Allergy and Infectious Diseases; Rheumatology Research Foundation Investigator Awards and Medical Education Award; Boston Children's Hospital Faculty Career Development Awards; the McCance Family Foundation; and the Samara Jan Turkel Center.
  • |*Immunomodulation[MESH]
  • |*Systemic Inflammatory Response Syndrome/blood/diagnosis/drug therapy/immunology[MESH]
  • |Adolescent[MESH]
  • |Adrenal Cortex Hormones/*administration & dosage[MESH]
  • |Betacoronavirus/*metabolism[MESH]
  • |Biomarkers/blood[MESH]
  • |COVID-19[MESH]
  • |Child[MESH]
  • |Child, Preschool[MESH]
  • |Female[MESH]
  • |Fibrin Fibrinogen Degradation Products/metabolism[MESH]
  • |Humans[MESH]
  • |Immunoglobulins, Intravenous/*administration & dosage[MESH]
  • |Infant[MESH]
  • |Interleukin 1 Receptor Antagonist Protein/*administration & dosage[MESH]
  • |Interleukin-10/blood[MESH]
  • |Interleukin-6/blood[MESH]
  • |Macrophage Activation Syndrome/blood/diagnosis/drug therapy/immunology[MESH]
  • |Male[MESH]
  • |Mucocutaneous Lymph Node Syndrome/blood/diagnosis/drug therapy/immunology[MESH]
  • |Natriuretic Peptide, Brain/blood[MESH]
  • |Retrospective Studies[MESH]


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