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SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment

  • Abdel-Haq, Nahed1, 2, 3
  • Asmar, Basim I.1, 2, 3
  • Deza Leon, Maria P.1
  • McGrath, Eric J.1, 2
  • Arora, Harbir S.1, 2, 3
  • Cashen, Katherine1, 2, 3
  • Tilford, Bradley1, 3
  • Charaf Eddine, Ahmad1, 3
  • Sethuraman, Usha1, 2, 3
  • Ang, Jocelyn Y.1, 2, 3
  • 1 Children’s Hospital of Michigan,
  • 2 Wayne State University,
  • 3 Central Michigan University,
Published Article
European Journal of Pediatrics
Publication Date
Jan 16, 2021
DOI: 10.1007/s00431-021-03935-1
PMID: 33452570
PMCID: PMC7810600
PubMed Central
  • Original Article


This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children’s Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)–like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered. Conclusion : MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome. What is Known: • Multisystem inflammatory syndrome in children (MIS-C) manifestations include fever, gastrointestinal symptoms, shock, and occasional features of Kawasaki disease (KD). • Treatment includes immunomodulatory agents, most commonly IVIG and corticosteroids. What is New: • Spectrum of MIS-C varies from mild to severe inflammation and coronary artery dilatation occurred in 5/22 (23%) critically ill patients. • IVIG and infliximab therapy were associated with a favorable outcome including resolution of coronary dilatation; only 2/33 received corticosteroids.

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