Clinical Profile, Outcome, and Short-Term Follow-up of Pediatric Multisystem Inflammatory Syndrome Cases in a Tertiary Care Center of Western India

Abstract

Abstract Background: There are several reports of the pediatric multisystem inflammatory syndrome associated with COVID-19 in children globally. The current Indian data on PIMS-TS associated with COVID-19 are scarce. Aims and Objectives: To describe demographic, clinical and laboratory findings, management, and follow - up of cases of PIMS-TS. Materials and Method: We analyzed children presenting to our hospital from July 2020 to January 2021, with PIMS-TS. Cases were categorized into two subsets: Group 1 (MIS-C with shock) and Group 2 (MIS-C without shock). Coronary Z scores of >2.5 were considered as dilated. We followed all the patients at 15 days, 3 months, 6 months, and 12 months. Results: Total 11 patients with diagnosis of MIS-C were treated during this study period. Mean age of presentation was 6.5 years. All patients in Group 1 needed inotropic support and treated with steroids and intravenous immunoglobulin. Three patients required administration of tocilizumab. All these were girls <6 years with neutrophil to lymphocyte ratio (NLR) >3.5, had dilated cardiac chambers with significantly decreased ventricular ejection fractions and dilated coronary arteries. Mean length of hospital stay was around 10 days. In Group 1, gastrointestinal and cardiovascular symptoms were prominent. While in group 2, prominent symptoms were gastrointestinal and mucocutaneous. Conclusion: Most of the children in this study had coronary artery abnormalities, low incidence of RT-PCR positivity and presence of SARS–CoV-2 antibodies. Use of tocilizumab to control the inflammatory response is likely to be beneficial in steroid resistant cases. Coronaries and cardiac function reverts to normal in a month without any residual effects.