Multisystem Inflammatory Syndrome Associated With Sars-Cov-2 Infection in 45 Children: A First Report From Iran Publisher Pubmed



Mamishi S^{1, 2} ; Movahedi Z³ ; Mohammadi M⁴ ; Ziaee V^{5, 6} ; Khodabandeh M¹ ; Abdolsalehi MR¹ ; Navaeian A¹ ; Heydari H³ ; Mahmoudi S² ; Pourakbari B² Show Affiliations
Source: Epidemiology and Infection Published:2020

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has similar clinical presentation to Kawasaki disease, toxic shock syndrome, and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the 3 pediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom, Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between March 07 and June 23, 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/ vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%), and hands and feet edema (40%) with median duration of symptoms prior to presentation of 5 (IQR 3, 7) days. Fifty-Three percent of children showed lymphopenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (500 ng/mL) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dL, D-dimer was 3909 (IQR 848, 4528) ng/mL, and troponin was 0.6 (IQR 0.1, 26) ng/mL, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatremia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis, and pericardial effusions were found in 18%, 11%, 4%, and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalized children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin, and albumin; and multi-organ involvement. © 2020 Journal of Physical Chemistry. All rights reserved.