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Volume 27, Number 4—April 2021
Dispatch

Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea

Young June Choe, Eun Hwa ChoiComments to Author , Jong Woon Choi, Byung Wook Eun, Lucy Youngmin Eun, Yae-Jean Kim, Yeo Hyang Kim, Young A. Kim, Yun-Kyung Kim, Ji Hee Kwak, Hyuk Min Lee, Hyunju Lee, Joon Kee Lee, June Dong Park, Eun-Jin Kim, Young Joon Park, Jin Gwack, and Sang Won Lee
Author affiliations: Korea University Anam Hospital, Seoul, South Korea (Y.J. Choe); Seoul National University College of Medicine, Seoul (E.H. Choi, H. Lee, J.D. Park); Bundang Jesaeng General Hospital, Seongnam, South Korea (J.W. Choi); Eulji University School of Medicine, Seoul (B.W. Eun); Yonsei University College of Medicine, Seoul (L.Y. Eun, H.M. Lee); Sungkyunkwan University School of Medicine, Seoul (Y.-J. Kim, J.H. Kwak); School of Medicine Kyungpook National University, Daegu, South Korea (Y.H. Kim); Pusan National University Children's Hospital, Yangsan, South Korea (Y.A. Kim); Korea University College of Medicine, Seoul (Y.-K. Kim); Chungbuk National University Hospital, Cheongju, South Korea (J.K. Lee); Korea Disease Control and Prevention Agency, Cheongju (E.-J. Kim, Y.J. Park, J. Gwack, S.W. Lee)

Main Article

Table

Demographics, clinical features, treatments, and outcomes of the 3 COVID-19–associated MIS-C case-patients, South Korea, May–November 2020*

Characteristics Case 1 Case 2 Case 3
Age, y
 11
 11
 14
Sex
 Boy
 Boy
 Girl
Underlying disease
 None
 None
 None
Clinical signs and symptoms
Initial symptoms Fever, abdominal pain Fever, abdominal pain, headache, nausea, vomiting Fever, abdominal pain, diarrhea
Fever Present Present Present
Conjunctival injection Present Present Present
Mucosal change Present None Present
Skin rash Present None Present
Extremity changes Present None Present
Lymphadenopathy None None None
Gastrointestinal symptoms Present Present Present
Hypotension
 Present
 Present
 Present
Inflammatory markers (peak)
Leukocyte (neutrophil %), 103/μL 7.55 (87) 9.55 (82.8) 26.56 (93)
ESR, mm/h NT 82 77
CRP, mg/L 18.95 10.36 >30
Fibrinogen, mg/dL 633 NT NT
Procalcitonin, ng/mL 14.55 1.54 9.62
D-dimer, μg/mL 894 2.5 3.95
Ferritin, μg/mL NT 2485 663
IL-6, pg/mL
 NT
 NT
 2410
Abnormal imaging studies
Echocardiography Coronary dilatation Mitral regurgitation Coronary dilatation, left ventricle dysfunction
Chest radiography or CT Bilateral pleural effusion, pneumonic infiltration Suspected pulmonary edema Bilateral pulmonary edema, pleural effusion
Abdominal ultrasound or CT
 Abdominal lymphadenopathy
 Mesenteric lymphadenopathy
 Hyperechoic liver, gallbladder hypertrophic edema, peripancreatic fluids, splenomegaly, scant pelvic ascites
Treatment
IVIg Provided Provided Provided
ASA Provided Provided Provided
Steroids Not provided Not provided Provided
Immunomodulatory Not provided Not provided Provided (Anakinra)
Inotropic agent Provided Not provided Provided
ICU care Provided Not provided Provided
Mechanical ventilator
 Not provided
 Not provided
 Not provided
Outcome
Hospitalization, d 12 d 10 d 19 d
ICU admission, d 6 d NA 7 d
Prognosis Improved, discharged Improved, discharged Improved, discharged

*MIS-C clinical case definition is as follows: age <19 y, fever >38.0°C for >24 h, laboratory evidence of inflammation (i.e., elevation of ESR, CRP, fibrinogen, procalcitonin, d-dimer, ferritin, LDH, IL-6, neutrophilia, lymphopenia, hypoalbuminemia), multisystem involvement (>2 organ systems involved), severe illness requiring hospitalization, and no other plausible microbial cause of inflammation (i.e., bacterial sepsis, staphylococcal/streptococcal toxic shock syndromes, enteroviral myocarditis). Evidence of SARS-CoV-2 exposure history defined as positive SARS-CoV-2 by RT-PCR, positive serology (neutralizing antibody or anti-SARS-CoV-2 IgG), or exposure to individual with COVID-19 <4 weeks before onset of symptoms (epidemiologic linkage with individual or cluster). ASA, acetylsalicylic acid; COVID-19, coronavirus disease 2; CRP, c-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; ICU, intensive care unit; IL-6, interleukin 6; IVIg, intravenous immunoglobulin; LDH, lactate dehydrogenase; MIS-C, multisystem inflammatory syndrome in children; NA, not applicable; NT, not tested; RT-PCR, reverse transcription PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Main Article

Page created: February 02, 2021
Page updated: March 18, 2021
Page reviewed: March 18, 2021
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