BACKGROUND AND PURPOSE:

• Riphagen et al. (The Lancet, 2020) provide one of the initial reports of  a cluster of hyperinflammatory shock cases in children, linked to COVID-19 and now known as Pediatric Multi-System Inflammatory Syndrome

METHODS:

• Setting
  • South Thames Retrieval Service in London, UK
• Patients
  • 8 children with hyperinflammatory shock (similar to atypical Kawasaki disease, Kawasaki disease shock syndrome, or toxic shock syndrome)
  • Previously well
  • Demographic info
    • 6 children were of Afro-Caribbean descent
    • 5 males | 3 females
    • 7 were well above 75th centile for weight
    • 4 had known exposure to SARS-CoV-2

RESULTS:

• Clinical presentation
  • Persistent fever (38–40°C)
  • Variable rash
  • Conjunctivitis
  • Peripheral edema
  • Generalized extremity pain
  • Significant GI symptoms
  • Most did not have significant respiratory involvement
• Laboratory evidence of infection/inflammation
  • Increased levels of CRP, procalcitonin, ferritin, triglycerides, and D-dimers
• SARS-CoV-2 testing
  • All patients negative for virus
  • Pathogen only identified in 1 child (adenovirus and enterovirus)
• Echocardiographic finding
  • Echo-bright coronary vessels were a common finding
  • One patient developed a giant coronary aneurysm within a week of discharge from pediatric intensive care (PICU)
    • Patient died following a right MCA and ACA ischemic infarction
• Treatment
  • All children received
    • IVIG (2 g/kg) in the first 24 hours and ceftriaxone and clindamycin
    • Six children were given 50 mg/kg aspirin
• Outcomes
  • Children discharged from PICU after days 4 to 6
  • 2 children subsequently tested positive for SARS-CoV-2
  • All children continue to be monitored for coronary abnormalities

CONCLUSION:

• In a follow up since submission of the manuscript
  • All 8 children were antibody positive for SARS-CoV-2
  • The hospital has treated >20 children with a similar clinical presentation
  • Multiple other centers have identified a similar constellation of findings that has now been named the Pediatric Multi-System Inflammatory Syndrome (see ‘Related ObG Topics’ for a review) 

Learn More – Primary Sources:

Hyperinflammatory shock in children during COVID-19 pandemic