Hyperinflammatory status associated with COVID-19: clinical features of a pediatric series.

OBJECTIVE

Explore clinical features, atypical manifestations and rare autoimmune complications of pediatric hyperinflammatory manifestations associated to SARS-CoV-2, observed during the COVID-19 pandemic, and the relationship of Multisystemic Inflammatory Syndrome of Childhood (MIS-C) with other manifestations, such as macrophage activation syndrome, vasculitis and vasculopathy.

METHODS

A protocol with detailed socio-demographic and clinical features, SARS-CoV-2 exposure and morbidity was conducted in a public tertiary hospital as part of a multicentric international protocol. Cases were selected and enrolled in a single centre from 2020 to 2022, recording all the organ and systems manifestations, standard treatment and outcome.

RESULTS

Of the 23 suspicious cases, 21 met the inclusion criteria of MIS-C. Gastrointestinal manifestations were frequent, and three out of 21 had acute abdomen, one with documented histiocytic necrotizing mesenteric lymphadenopathy (Kikuchi-Fujimoto), 3 had macrophage activation syndrome (MAS), and one case, with previous enthesitis related arthritis evolved into type V Takayasu arteritis and malignant hypertension. All patients were treated with either intravenous immunoglobulin (IVIG), high dose glucocorticoids or both, five were under intensive care treatment with respiratory and cardio-circulatory support. All had full recovery during acute phase. Description the lymphonode histopathology showed proliferation of small lymphocytes and macrophage infiltrates with microthrombi and lymph nodes germinal centers necrosis.

CONCLUSION

Post-infectious hyperinflammatory states associated with COVID-19 manifestations may cause not only to transient inflammatory features, but also autoimmunity, vasculitis and vasculopathy manifestations that require prompt treatment.