72 Paediatric multisystem inflammatory syndrome, a new entity: a 3-case series

Introduction/DescriptionCovid-19 is usually mildly symptomatic in children. However, in April 2020 the first reports of an inflammatory generalized syndrome associated withSARS-CoV-2 emerged. We report 3 cases of this new entity in a secondary hospital.A 9-year-old female, with a low-risk contact with SARS-COV 2 infected person, was admitted to the Emergency Department (ED) due to persistent fever with lasting for 6 days, fleeting rash at the trunk, oral mucositis, cheilitis and painful cervical lymphadenopathies. Laboratory studies showed leucocytosis, elevation of erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), D-Dimers and fibrinogen. Echocardiography depicted hyperechogenicity in the coronary arteries. Treatment with a single dose of intravenous immunoglobulin (IVIg) and aspirin (ASA) was performed, but clinical worsening motivated the introduction of oral corticotherapy. She was discharged after 8 days with clinical and analytical improvement.An 8-year-old female, infected with SARS-COV-2 twenty days before the admission, presented to the ED complaining of persistent fever with a 2-days evolution, associated with abdominal pain and maculopapular rash in the trunk and face. Laboratory data showed lymphopenia, thrombocytopenia and elevation of inflammatory markers (CRP, ESR and ferritin), D-Dimers, fibrinogen and cardiac enzymes. Echocardiography revealed hyperechogenicity of the coronary arteries. She began treatment with IV methylprednisolone pulses for 3 days, ASA and oral corticoid. A clinical and analytical improvement was observed and she was discharged after 8 days of hospitalization.A 12-year-old female, infected with SARS-COV 2 one month before, was admitted to the ED due to persistent fever with a 2-days evolution.Analytical study revealed lymphopenia, thrombocytopenia, elevation of CRP and D-Dimers. The child was hospitalized for clinical surveillance. After 5 days of hospitalization, she referred more tiredness associated with persistent fever and bilateral non-exudative conjunctivitis. Laboratory data showed elevation of inflammatory markers and D-Dimers, worsening of thrombocytopenia, hypoalbuminemia and elevation of troponin.Echocardiography evaluation was normal. IVIg and oral ASA was initiated with analytical and clinical improvement. In this case, genomic sequencing was possible and the variant SARS-COV 2 B.1.221 was identified.ConclusionPaediatric Multisystem Inflammatory Syndrome temporally associated withCovid-19 (PIMS-TS) is a new entity not always a straightforward diagnosis.Considering the virus dissemination, it is hard to keep track of the potential high-risk contacts. Therefore, we should be aware of PIMS-TS to archive an early diagnosis and potentially avoid severe complications. There is still insufficient data to conclude if certain variants are more susceptible to cause this syndrome.