Clinical Profile of Children with Multisystem Inflamatory Syndrome (MIS-C) in Bahrain

Abstract: BACKGROUND MIS-C a rare but severe complication of covid -19 infection-causing multi-organ failure

Objective: To describe the clinical, laboratory profile, and treatment outcome of children diagnosed with Multisystem Inflammatory Syndrome (MIS-C) during the Covid-19 pandemic.

Methods: We conducted a prospective observational study of seven confirmed cases of MIS-C at our institution from June to September 2020. The clinical presentation, laboratory studies, complications, and treatment responses were collected.

Results: Seven patients fulfilled the WHO case definition of MIS-C. The median age at presentation was 7.4 years (range 9 months to 14 years); One (14.3%) of the patients had a preexisting illness. Six children (85.7%) had lab confirmation of the SARS-COV-2 infection. Three patients (42.8%) were males. Six (85.7%) presented with fever, two (28.5) % had a rash, two (28.5%) had a conjunctival injection, one (14.3%) had mucosal changes, two (28.5%) had cardiac involvement, three (42.8%) had lymphopenia, five (71.4%) had thrombocytopenia and all seven (100%) had an elevation in inflammatory markers (CRP, D-Dimer, Ferritin, and IL-6). Four (57.1%) had coagulopathy, one (14.3%) had hyperacute liver failure, one (14.3%) had pancreatitis, one (14.3%) presented with mixed central and peripheral nervous system manifestations. Three patients (42.8%) required mechanical ventilation and inotropic support. Immunomodulator therapy was given to five patients (83.35) included intravenous immunoglobulin (IVIG), Aspirin, and corticosteroids. Clinical and laboratory improvements were observed in all patients.

Conclusion: This case series of hospitalized children who met the criteria for MIS-C, encompasses a broad phenotypic spectrum and disease severity, ranging from fever and inflammation to myocardial injury, hyperinflammatory shock, nervous system involvement, and other organ involvement. There is a complete resolution of symptoms and laboratory parameters with immunomodulatory therapy.