June 16, 2020

GI Symptoms Are a Major Presentation Component of Multisystem Inflammatory Syndrome in Children

By Denise Baez

NEW YORK -- June 16, 2020 -- Gastrointestinal (GI) symptoms are a major presentation component of the novel multisystem inflammatory syndrome in children (MIS-C) that is related to coronavirus disease 2019 (COVID-19), according to a study published in Gastroenterology.

Although MIS-C is characterised by systemic hyperinflammation with fever and multi-system organ dysfunction, GI symptoms are increasingly recognised to be associated with the presentation of MIS-C, potentially confusing the diagnosis of MIS-C with other common, less toxic GI infections and even inflammatory bowel disease, according to Jonathan Miller, MD, Morgan Stanley Children’s Hospital, and Columbia University Irving Medical Center, New York, New York, and colleagues.

A retrospective chart review of 44 patients (median age, 7.3 years) who were hospitalised with MIS-C at the Children’s Hospital at Columbia University Irving Medical Center between April 18 and May 22, 2020, found that 84.1% presented with ≥1 GI symptom, including abdominal pain (75%), vomiting (56.8%), diarrhoea (40.1%), nausea (18.2%), and constipation (11.4%). These symptoms were most often accompanied by fever (100%) and rash (70.5%).

Interestingly, 29.5% had presented within 7 days prior to admission at an emergency room or urgent care centre for less severe symptoms such as fever and GI symptoms mimicking a viral gastroenteritis but without other systemic symptoms.

All patients had either documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure with clinically compatible symptoms, a positive SARS-CoV-2 nasopharyngeal swab by real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay (34.1%) or positive antibodies against SARS-CoV-2 spike trimer or nucleocapsid protein (96.9%).

In contrast to adults, only 25% of the patients with MIS-C required supplemental oxygen and 1 patient was intubated.

Abdominal imaging studies were performed in 15 patients, and findings included mesenteric adenitis (n = 2), biliary sludge or acalculous cholecystitis (n = 6), ascites (n = 6), and bowel wall thickening (n = 3).

Methylprednisolone and/or hydrocortisone was given to 42 (95.5%) patients, 36 (81.8%) received intravenous immune globulin, 8 (18.2%) received anakinra, and 40 (90.1%) receiving anticoagulation.

At the time the study was published, gall except 1 were discharged and there were no fatalities.

“These data suggest that the vast majority of patients who develop [MIS-C] present with GI symptoms mimicking GI infection or even inflammatory bowel disease,” the authors concluded. “MIS-C should thus be considered in patients with prominent GI symptoms and a history of recent SARS-CoV-2 exposure or infection. Although not uniformly, MIS-C can differ from these other conditions in both its clinical comorbidities as well as extremely high inflammatory markers. Amongst follow-up for other potential sequelae of organ dysfunction, long-term follow-up for the GI manifestations in some of these patients may warrant surveillance for IBD.”

Reference: https://www.gastrojournal.org/article/S0016-5085(20)34753-3/pdf

SOURCE: Gastroenterology
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