Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.

Abstract

Second wave of the new coronavirus (SARS-CoV-2) has been declared throughout the world. It has been always thought that children are the least affected group. A new childhood disease, referred to as MIS-C (Multisystem Inflammation Syndrome) or PIMS-TS (Pediatric Inflammatory Multiorgan Syndrome Temporally related to SARS-CoV-2) was first recognized in April 2020. Shock and multiorgan failure affected some of those children that required intensive care; others were clinically similar to Kawasaki disease or toxic shock. The clinical evidence suggests that this inflammatory multisystem syndrome is temporally associated with severe acute respiratory syndrome corona virus 2. Many clinical uncertainties regarding this new disease rapidly became apparent in prevalence, clinical phenotypes, variable severity, clinical course, and optimal management. We aim to increase awareness of this syndrome regarding the diagnosis and management of children with suspected PIMS-TS by presenting two clinical cases and illustrating the available medical literature in regards to establishing the diagnosis and the appropriate therapeutic interventions. SARS-Cov-2 related medical impacts on children seem not well clarified yet. When a PIMS-TS case is suspected then full investigations should be done, children who have persistent fever associated with abdominal pain, diarrhea ,vomiting ,cough, neurologic symptoms should have primary blood tests to identify PIMS-TS: full blood count, CRP: C-reactive protein,  BUN: Blood Urea Nitrogen, Cr: Creatinine, Electrolytes and liver function. Multidisciplinary team approach seems mandatory from the very beginning. Despite the use of IVIG in the treatment of all diagnosed cases, steroids in regular doses could be a good alternative and requires further investigative evaluations.