Pediatric Inflammatory Multisystem Syndrome (PIMS) characteristics, a single center report

Introduction: Following the spread of the COVID-19 pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS). The clinical syndrome showed some heterogeneity with patients presenting either akin to toxic shock, Kawasaki-disease like or with undifferentiated inflammatory characteristics.

Methods: Single center retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from October-2020 to November-2021, admitted to our Pediatric department at Poria medical center.

Results: Seven patients admitted with PIMS. Six were males. All patients presented with fever, while six presented with gastrointestinal symptoms and only one patient admitted with respiratory complaints. Five patients had skin rash and four presented with conjunctivitis and cracked lips. Laboratory tests revealed Raised C-reactive protein (CRP) in all patients, Lymphopenia and Hyponatremia in six patients. Ferritin and D-dimer levels were elevated in all patients. Interestingly, prolonged INR and elevated Troponin levels were observed in three of the patients. Two of our patients diagnosed with myocarditis, one with moderate mitral regurgitation and one with dilated right coronary artery. All patients were treated by pulse steroid therapy for three consecutive days and six of them were additionally given Intravenous immunoglobulines. Several days later, a full recovery was observed and the blood tests were normalized.

Interpretation: The results suggest that a proportion of children with PIMS present with a non-specific febrile illness and abnormal blood results. Significant improvement with steroids and IVIG combination therapy. Further research is needed to determine the most appropriate identification, treatment and follow-up of these children.