Publication:

Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 in Indian children: Pune experience

Background Aim was to study the clinical profile, laboratory parameters and outcome of children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).

Methods This is an observational study done in a PICU of a tertiary care teaching hospital in Pune conducted over seven months starting from 1st June to 31st December, 2020 and which included the children meeting the case definition of PIMS-TS.

Results A total 25 children were included of which 13 (52%) were males. Median age was 7 years. Fever of short duration was present in all children and 23 (92%) had gastrointestinal symptoms. 21 (84%) had features of shock while myocardial dysfunction was seen in eight (32%) children. Kawasaki disease like features were present in seven (28%) while five (20%) showed coronary artery dilatation. All had neutrophilia and lymphopenia while 10 (40%) showed thrombocytopenia. Interleukin-6 levels, done in six, and were found to be raised in all. SARS-CoV-2 RT-PCR and IgG antibody were positive in two while only IgG was positive in 14 (56%) children. Seven required mechanical ventilation while eleven were managed with HFNO. 16 (64%) children received both IVIG and steroids, two (8%) children received only IVIG while seven (28%) received only steroids. Two children each additionally received Tocilizumab and infliximab. 24 (96%) children survived.

Conclusions Fever, gastrointestinal symptoms and hypotensive shock were predominant features of PIMS-TS. 2/3rd of children had demonstrable SARS-CoV-2 antibodies. Cardiac dysfunction was seen in 1/3rd of the children. It is a life-threatening illness requiring critical interventions, multi-organ support and various immunomodulators.