Multisystem inflammatory syndrome in children associated with novel coronavirus SARS-CoV-2: Presentations to a pediatric emergency department in Michigan

• Published in: The American journal of emergency medicine 2021-01, Vol.39, p.164-167
• Main Authors: Sethuraman, Usha, Kannikeswaran, Nirupama, Ang, Jocelyn, Singer, Adam, Miller, Jason, Haddad, Rita, Stankovic, Curt
• Format: Article
• Language: English
• Subjects: Adults; Age; Asymptomatic; Cardiovascular disease; Child; Children; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - physiopathology; COVID-19 diagnostic tests; Diagnosis, Differential; Dopamine; Electrocardiography; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Hispanic Americans; Humans; Hypotension; Illnesses; Immunoglobulins; Infections; Inflammation; Intensive care; Male; Medical laboratories; Michigan; Mucocutaneous Lymph Node Syndrome; Multisystem inflammatory syndrome in children; Pandemics; Patients; Pediatrics; Serology; Severe acute respiratory syndrome coronavirus 2; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - physiopathology; Viral infections
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.10.035

The SARS-CoV-2 is a respiratory virus of the coronavirus family responsible for a global pandemic since December 2019. More than 35 million people have been affected with the novel coronavirus disease (COVID-19), with more than one million deaths worldwide. Michigan was one of the top three states in the United States that was severely affected by the SAR-CoV-2 pandemic with more than 7000 deaths in adults and greater than 145,000 confirmed infections. However, compared to adults, the majority of children until recently were either asymptomatic or had a mild illness with SARS-CoV-2. Recently, a rare but potentially serious presentation associated with SARS-CoV-2 called multisystem inflammatory syndrome in children (MIS-C) has been recently reported and the Centers for Disease Control (CDC) released a case definition for the same. We report the clinical and laboratory presentations and outcomes of 34 children with MIS-C who were evaluated within a 12 week period at a pediatric emergency department (PED) of single institution in Michigan. These cases presented approximately three weeks after the peak of adult SAR-CoV-2 related deaths occurred in the state. While many children presented with clinical characteristics similar to incomplete Kawasaki disease (KD), they also exhibited certain unique features which differentiated MIS-C from KD. The information presented below will aid clinicians with early recognition, evaluation and management of MIS-C in the emergency department.