Most Inflammatory, Cardiac Manifestations of MIS-C Resolve

MONDAY, July 26, 2021 -- Most inflammatory and cardiac manifestations of multisystem inflammatory syndrome in children (MIS-C) resolve relatively quickly, according to a study published online July 15 in Pediatrics.

Kanwal M. Farooqi, M.D., from NewYork-Presbyterian/Columbia University Irving Medical Center in New York City, and colleagues reported longitudinal outcomes for all 45 children younger than 21 years of age admitted to NewYork-Presbyterian with MIS-C in 2020. The median time to last follow-up was 5.8 months.

The researchers found that 76 percent of those admitted required intensive care and 64 percent required vasopressors and/or inotropes. Patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia on admission. Elevated soluble interleukin (IL)-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were observed. Eighty percent had at least mild and 44 percent had moderate-severe echocardiographic abnormalities, including coronary abnormalities. By one to four weeks, most inflammatory markers normalized, but 32 percent exhibited persistent lymphocytosis, with increased double-negative T cells in 96 percent of the 24 assessed patients. Only 18 percent had mild echocardiographic findings by one to four weeks; all had normal coronaries. The proportion of double-negative T cells remained elevated in 92 percent by one to four months. Only one child had persistent mild dysfunction at four to nine months; one child had mild mitral and/or tricuspid regurgitation.

"Given the unexpected, persistent immunologic findings, both optimism and continued caution and follow-up are recommended to ensure the health of children with MIS-C and to further inform our understanding of this disease," the authors write.

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Posted July 2021