Author: Michael A. Evans, MD – Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine
A previously healthy 8-year-old male presents with three days of high fever, diarrhea, and abdominal pain. On exam, he exhibits conjunctivitis, cracked lips, and edema of the hands and feet. Both parents had positive SARS-CoV-2 nasopharyngeal swabs. You suspect Multisystem Inflammatory Syndrome in Children (MIS-C). Which of the following common cardiovascular manifestations of MIS-C is MOST LIKELY to be found in this patient?
Correct!
Wrong!
Question of the Week 319
In the largest case-series of children diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) published to date, 80% of patients had cardiovascular involvement. Of those with cardiovascular findings: 73% had B-type natriuretic peptide (BNP) > 400 ng/L, 50% had elevated troponin, and 8% had coronary aneurysms > 2.5mm on echocardiography. Beyond elevated BNP and troponin, elevations in C-reactive protein (CRP), procalcitonin (PCT), and erythrocyte sedimentation rate (ESR) are typically found in patients with MIS-C.
Many other smaller case-series of MIS-C patients have been reported in the literature. The incidence of ventricular dysfunction has varied widely from 35-100% of children diagnosed with MIS-C depending on the publication. Six to fourteen percent of these patients did not fully recover their LV function prior to hospital discharge. Forty-eight percent of patients with cardiac involvement require vasoactive support, and 80% of all children diagnosed with MIS-C require intensive care. Two percent of children with MIS-C die.
In a report of 186 pediatric patients diagnosed with SARS- CoV-2, the most predominant organ systems involved in MIS-C were gastrointestinal (92%), cardiovascular (80%), hematologic (76%), and mucocutaneous (74%). This was followed by respiratory involvement in 70% of pediatric patients. This differs from the incidences of organ system involvement in adults diagnosed with SARS-CoV-2.
References
1. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020; 383(4): 334-346. doi:10.1056/
2. Sperotto F, Friedman KG, Son MBF, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 2021; 180(2): 307-322.
3. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020; 395(10237): 1607-1608. doi:10.1016/S0140-6736(20)31094-1
4. Belhadjer Z, Méot M, Bajolle F, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation. 2020; 142(5): 429-436. doi:10.1161/CIRCULATIONAHA.120.048360
5. Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020; 395(10239): 1771-1778. doi:10.1016/S0140-6736(20)31103-X
6. National Center for Immunization and Respiratory Diseases (NCIRD). Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/mis-c/cases/index.html. Updated March 29, 2021. Accessed April 25, 2021.
Many other smaller case-series of MIS-C patients have been reported in the literature. The incidence of ventricular dysfunction has varied widely from 35-100% of children diagnosed with MIS-C depending on the publication. Six to fourteen percent of these patients did not fully recover their LV function prior to hospital discharge. Forty-eight percent of patients with cardiac involvement require vasoactive support, and 80% of all children diagnosed with MIS-C require intensive care. Two percent of children with MIS-C die.
In a report of 186 pediatric patients diagnosed with SARS- CoV-2, the most predominant organ systems involved in MIS-C were gastrointestinal (92%), cardiovascular (80%), hematologic (76%), and mucocutaneous (74%). This was followed by respiratory involvement in 70% of pediatric patients. This differs from the incidences of organ system involvement in adults diagnosed with SARS-CoV-2.
References
1. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020; 383(4): 334-346. doi:10.1056/
2. Sperotto F, Friedman KG, Son MBF, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 2021; 180(2): 307-322.
3. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020; 395(10237): 1607-1608. doi:10.1016/S0140-6736(20)31094-1
4. Belhadjer Z, Méot M, Bajolle F, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation. 2020; 142(5): 429-436. doi:10.1161/CIRCULATIONAHA.120.048360
5. Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020; 395(10239): 1771-1778. doi:10.1016/S0140-6736(20)31103-X
6. National Center for Immunization and Respiratory Diseases (NCIRD). Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/mis-c/cases/index.html. Updated March 29, 2021. Accessed April 25, 2021.
