In recent weeks, a multisystem hyperinflammatory condition has emerged in children in association with prior exposure or infection to SARS-CoV-2. A new case series published in the journal Radiology examines the spectrum of imaging findings in children with the post-COVID-19 inflammatory condition known in the U.S. as Multisystem Inflammatory Syndrome in Children (MIS-C).
The array of findings includes airway inflammation and rapid development of pulmonary edema, coronary artery aneurysms, and extensive intra-abdominal inflammatory changes.
The children had a variety of symptoms, including fever, headaches, abdominal pain, rash, and conjunctivitis. Clinical features and lab findings shared some similarities to those of Kawasaki disease--which causes inflammation in the walls of blood vessels--Kawasaki-disease shock syndrome or toxic-shock syndrome, although atypical and more severe.
For the study, researchers performed a retrospective review of clinical, laboratory, and imaging findings of the first 35 children under age 17 who were admitted to the pediatric hospital that met the case definition for MIS-C. The children were admitted from April 14 to May 9, 2020, and included 27 boys and eight girls, with a median age of 11 years old.
The most common clinical presentation was fever, found in 33 (94 percent) of the children, gastrointestinal symptoms including abdominal pain, vomiting and diarrhea in 30 (86 percent) of the children, rash (13 or 37 percent), and conjunctivitis (9 or 26 percent).
Twenty-one children (60 percent) were in shock. Clinical status was severe enough to warrant management in the pediatric intensive care unit in 24 of 35 children (69 percent), of which 7 (20 percent) required mechanical ventilation and 20 (57 percent) inotropic support.
Two children required extracorporeal membrane oxygenation (ECMO) due to severe myocardial dysfunction. Lab tests revealed that all of the children had abnormal white blood cell counts.
The study identified a pattern of imaging findings in post-COVID-19 MIS-C, including airway inflammation, rapidly progressive pulmonary edema, coronary artery aneurysms, and extensive abdominal inflammatory changes within the right iliac fossa.
All 35 children underwent chest X-ray due to fever, sepsis, or features of multisystem inflammation. Nineteen X-rays were abnormal, the most common finding being that of bronchial wall thickening. --Asian News