Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 Infection.

To the Editor: Multisystem inflammatory syndrome–children (MIS-C) is a newly recognized spectrum of disease manifestations in children associated with COVID-19 infection [1]. This letter aims to describe the clinicotherapeutic profile of MIS-C COVID-19 cases admitted at a tertiary hospital in Delhi-NCR. We observed 12 cases with a median age of 6.5 y (9 male; 3 female). Eleven showed seropositivity for COVID-19 while 1 had a positive COVID-19 RT-PCR. As proposed by Gupta et al. [2], cases were divided into 3 groups: febrile inflammatory state (5 cases), Kawasaki-like illness (3 cases), and toxic shock syndrome-like classical MIS-C (4 cases). Fever was present in all cases. Gastrointestinal system was the most commonly affected system with vomiting being the most common symptom. Cardiovascular symptoms were seen in 6 (50%) cases. Three children showed neurological impairment with 1 case each of refractory status epilepticus, acute disseminated encephalomyelitis (ADEM), and necrotizing encephalopathy. Respiratory system was involved in 5 (41.6%) children. Elevated CRP was noted in all children, elevated ferritin in 8 (66.7%), elevated D-dimer in 10 (83.3%), and deranged PT/INR/aPTT in 4 (33%) cases. High Pro-BNP was seen in 8; of which, 4 showed deranged ejection fraction. Consolidation and/or pleural effusion was seen in 7 (58.3%) cases. All children received steroids, while 7 children received IVIg. LMWH and aspirin were given to children with raised D-dimer and Kawasaki-like illness, respectively. Six children needed vasopressor support. Three patients died during the course of the disease while 1 suffered morbidity in the form of hemiparesis. Rest all were discharged after full recovery of presenting symptoms.

MIS-C COVID-19 should be considered in cases with longstanding fever and/or multisystem involvement. In the absence of standardized guidelines, clinicians are often missing mild cases or misdiagnosing the presentation [3]. It also emphasizes the need for further studies in this field.