Multisystem inflammatory syndrome in children related to COVID‐19: A New York City experience

• Published in: Journal of Medical Virology 2021-01, Vol.93 (1), p.424-433
• Main Authors: Riollano‐Cruz, Mariawy, Akkoyun, Esra, Briceno‐Brito, Eudys, Kowalsky, Shanna, Reed, James, Posada, Roberto, Sordillo, Emilia Mia, Tosi, Michael, Trachtman, Rebecca, Paniz‐Mondolfi, Alberto
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Children; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - immunology; Cytokines; Cytokines - immunology; Female; Hispanic Americans; Humans; hyperinflammatory syndrome; Inflammatory diseases; Kawasaki disease; Male; Mucocutaneous lymph node syndrome; Multisystem inflammatory syndrome in children; New York City - epidemiology; Pandemics; Pathogenesis; Pediatrics; Respiratory diseases; Retrospective Studies; SARS‐CoV‐2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Systemic Inflammatory Response Syndrome - epidemiology; Tertiary Care Centers; Viral diseases; Virology; Young Adult
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.26224

In December 2019, the 2019, a novel coronavirus disease (COVID‐19) caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as a low risk for severe COVID‐19. However, reports have emerged recently of cases of COVID‐19 in children with a systemic inflammatory disease, with features that overlap with Kawasaki disease (KD). We describe the first 15 cases with the multi‐systeminflammatory syndrome in children (MIS‐C), temporally related to COVID‐19, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and Black/African American ancestry, the distinct cytokine signature across the disease spectrum (IL‐1/IL‐6), and the potential role and pathogenesis of SARS‐CoV‐2 in this new clinical entity. Highlights Multisystem Inflammatory Syndrome in Children (MIS‐C) is a rare pediatric condition characterized by hyperinflammation and multiorgan dysfunction frequently following an infectious trigger. MIS‐C associated with COVID‐19 is a severe presentation of SARS‐CoV‐2 infection in pediatric patients sharing overlapping features with Kawasaki disease. A distinct cytokine signature is seen across the disease spectrum with MIS‐C driven predominantly by IL‐6 and IL‐8. The disease appears to affect disproportionately children of Hispanic/Latino and Black/African American ancestry.