Immunoglobulins and corticosteroids for multisystem inflammatory syndrome in children
June 16. Nejm. Multisystem Inflammatory Syndrome in Children – Initial Therapy and Outcomes
An analysis of surveillance data on inpatient patients under the age of 21 with multisystem inflammatory syndrome and admitted to hospital between March 15 and October 31, 2020, showed that initial treatment with intravenous immunoglobulin plus glucocorticoids was associated lower risk of cardiovascular dysfunction and lower incidence of add-on therapy compared to IVIG alone Kawasaki disease or similar in children: case series and systematic review
Rheumatism. Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C / PIMS) at the time of COVID-19: are they all the same? Case series and literature reviewThree cases of Kawasaki disease-like disease (Kawasaki disease – KD) that occurred during the pandemic in a highly affected area of Northern Italy are reported. The clinical presentation is characterized by the presence of incessant fever, diarrhea, and elevated inflammatory markers.
Case No. 1 and case no. 2 occurred a week apart and shared other clinical features: laboratory tests confirmed exposure to COVID-19 and high inflammatory activation with myocardial involvement. Case No. 3 followed a more typical pattern for KD.
Interestingly, the third patient showed lower levels of procalcitonin, C-reactive protein, D-dimers and ferritin than the other two cases, while the platelet count was higher. We hypothesize that SARS-CoV-2 may act as a trigger in children, inducing a classic KD phenotype or causing a systemic inflammatory response leading to a severe KD-like phenotype, also characterized by myocardial damage.
Kawasaki disease relapses in the COVID-19 era: systematic review
April 19, 2021. Ital J Pediatr. Kawasaki disease recurrence in the COVID-19 era: a systematic review of the literature
The authors reviewed the medical literature on Kawasaki disease relapses and reported a new case of Kawasaki disease relapse in a SARS-CoV-2 infected child. We believe that in our case the SARS Cov2 acted as a trigger capable of determining, in a genetically susceptible individual, a second relapse of the disease. In the Covid-19 era we affirm the importance of testing Kawasaki disease for SARS Cov2 infection.
- March 16, 2021. Pediatr Rheumatol Online J. Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey
- There is growing evidence for the existence of a pediatric inflammatory multisystem syndrome associated with SARS-CoV-2 (PIMS-TS) infection, which shares similarities with Kawasaki disease (KD).
- The study attempted to better specify the clinical features and treatment response of PIMS-TS and to explore its relationship to KD by determining whether KD and PIMS are two distinct entities.
The results suggest that SARS-CoV-2 infection could lead to two distinct inflammatory diseases in children: KD and PIMS-TS. Advanced age at onset and clinical features such as the onset of myocarditis characterize the multi-inflammatory syndrome. Enrolled patients had an optimal response to treatments and a good outcome, with few complications and no deaths.