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      A case report on multisystem inflammatory syndrome in children (MIS‐C) associated with COVID‐19 infection

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          Abstract

          Key Clinical Message

          Early recognition and treatment of Multisystem Inflammatory Syndrome in Children (MIS‐C) within the context of COVID‐19 infection is crucial for improved outcomes. Prompt intervention with IVIG and steroids leads to significant improvement in a severe case of MIS‐C. Clinicians should be vigilant for MIS‐C symptoms and initiate timely management.

          Abstract

          We report a case involving a fourteen‐year‐old male with COVID‐19 infection who developed multisystem inflammatory disease. A previously healthy child presented with a history of 10 days of fever and cough, along with diarrhea, and vomiting for 3 days. His COVID‐19 infection was confirmed through Polymerase Chain Reaction (PCR), and the laboratory values were remarkable for high levels of C‐reactive protein, D‐dimers, B‐type natriuretic peptide (BNP), and troponin I. He developed circulatory shock on the second day of the presentation and needed inotropic support. Steroids and intravenous immunoglobulin (IVIG) were started in light of Multisystem Inflammatory Syndrome in Children (MIS‐C), which improved his condition. Thus, during the management of COVID‐19 infection, early detection and a careful clinical characterization for MIS‐C are essential.

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          Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study

          Summary Background In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs). We aimed to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Methods We did a multicentre observational study of children (aged <18 years), admitted to PICUs in the UK between April 1 and May 10, 2020, fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health. We analysed routinely collected, de-identified data, including demographic details, presenting clinical features, underlying comorbidities, laboratory markers, echocardiographic findings, interventions, treatments, and outcomes; serology information was collected if available. PICU admission rates of PIMS-TS were compared with historical trends of PICU admissions for four similar inflammatory conditions (Kawasaki disease, toxic shock syndrome, haemophagocytic lymphohistiocytosis, and macrophage activation syndrome). Findings 78 cases of PIMS-TS were reported by 21 of 23 PICUs in the UK. Historical data for similar inflammatory conditions showed a mean of one (95% CI 0·85–1·22) admission per week, compared to an average of 14 admissions per week for PIMS-TS and a peak of 32 admissions per week during the study period. The median age of patients was 11 years (IQR 8–14). Male patients (52 [67%] of 78) and those from ethnic minority backgrounds (61 [78%] of 78) were over-represented. Fever (78 [100%] patients), shock (68 [87%]), abdominal pain (48 [62%]), vomiting (49 [63%]), and diarrhoea (50 [64%]) were common presenting features. Longitudinal data over the first 4 days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (4030 μg/L to 1659 μg/L), and ferritin (1042 μg/L to 757 μg/L), whereas the lymphocyte count increased to more than 1·0 × 109 cells per L by day 3 and troponin increased over the 4 days (from a median of 157 ng/mL to 358 ng/mL). 36 (46%) of 78 patients were invasively ventilated and 65 (83%) needed vasoactive infusions; 57 (73%) received steroids, 59 (76%) received intravenous immunoglobulin, and 17 (22%) received biologic therapies. 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died. Interpretation During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown. Funding None.
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            CDC details COVID‐19‐related inflammatory syndrome in children

            M Jenco (2020)
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              Author and article information

              Contributors
              bhandariroshan369@gmail.com
              Journal
              Clin Case Rep
              Clin Case Rep
              10.1002/(ISSN)2050-0904
              CCR3
              Clinical Case Reports
              John Wiley and Sons Inc. (Hoboken )
              2050-0904
              03 April 2024
              April 2024
              : 12
              : 4 ( doiID: 10.1002/ccr3.v12.4 )
              : e8737
              Affiliations
              [ 1 ] Maharajgunj Medical Campus, Institute of Medicine Tribhuvan University Kathmandu Nepal
              [ 2 ] KIST Medical College and Teaching Hospital Tribhuvan University Lalitpur Nepal
              [ 3 ] Lady Hardinge Medical College New Delhi India
              Author notes
              [*] [* ] Correspondence

              Roshan Bhandari, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 44600, Nepal.

              Email: bhandariroshan369@ 123456gmail.com

              Author information
              https://orcid.org/0000-0002-8543-5972
              Article
              CCR38737 CCR3-2023-08-1694.R1
              10.1002/ccr3.8737
              10988666
              38571905
              5d5edf9d-d7f6-4ab4-b888-30219e295ca7
              © 2024 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

              This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

              History
              : 30 January 2024
              : 12 August 2023
              : 22 February 2024
              Page count
              Figures: 0, Tables: 1, Pages: 3, Words: 1500
              Categories
              Cardiovascular Disorders
              Critical Care Medicine
              Endocrinology and Metabolic Disorders
              Neurology
              Case Report
              Case Report
              Custom metadata
              2.0
              April 2024
              Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.0 mode:remove_FC converted:03.04.2024

              covid‐19,immunoglobulin therapy,inflammation,multisystem inflammatory syndrome in children (mis‐c),pediatric covid‐19 management

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