Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition that appears to be connected to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), might be successfully treated with immune globulin, according to a small observational study in Europe.
Zahra Belhadjer, MD, of Université de Paris, and colleagues retrospectively collected clinical, biological, therapeutic and early outcomes data in children who were admitted to pediatric intensive care units in 13 centers in France and Switzerland between March 22 and April 30.
Their findings were published online Sunday in Circulation.
The 35 children included in the study had a median age of 10 years (range, 2-16 years). About 28% had comorbidities, including asthma and being overweight. One-third had a left ventricular ejection fraction <30%, 80% required inotropic support, and 28% were treated with extracorporeal membrane oxygenation (ECMO).
The children has inflammation markers suggesting cytokine storm (interleukin 6 median 135 pg/mL) and macrophage activation (D-dimer median 5,284 ng/mL). Thirty-one of the patients (88%) tested positive for SARS-CoV-2 infection.
All patients received intravenous immune globulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in 25 of the 35 patients. No patients died, and all who were treated with ECMO were successfully weaned.
Belhadjer and colleagues write that their findings of a cluster of children suffering severe heart failure associated with MIS-C contrast with previous reports showing that the impact of COVID-19 in children is mild.
They further note that the Pediatric Intensive Care Society in the U.S. and other groups around the world have warned of a rise in the number of children presenting with MIS-C. The features of the syndrome overlap with toxic shock syndrome and atypical Kawasaki disease together with cardiac inflammation.
“Early diagnosis and management appear to lead to favorable outcome using classical therapies,” Belhadjer and colleagues conclude. “Elucidating the immune mechanisms of this disease will afford further insights for treatment and potential global prevention of severe forms. Identifying the genetic bases of individual susceptibility is also key to tailored prevention.”
Belhadjer Z, Méot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation 2020 May 17. https://doi.org/10.1161/CIRCULATIONAHA.120.048360