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J Pediatr Infect Dis 2022; 17(03): 126-136
DOI: 10.1055/s-0042-1745835
Original Article

Management of Multisystem Inflammatory Syndrome in Children with Combined Use of Corticosteroids and Intravenous Immunoglobulin—Report from Bursa, Turkey

Sefika Elmas Bozdemir 
1   Division of Pediatric Infectious Diseases, Department of Pediatrics, Bursa City Hospital, Bursa, Turkey
,
Esra Türe 
2   Division of Pediatric Emergency Diseases, Department of Pediatrics, Bursa City Hospital, Bursa, Turkey
,
Hakan Altin 
3   Division of Pediatric Cardiology, Department of Pediatrics, Bursa City Hospital, Bursa, Turkey
,
Sümeyye Ertek 
4   Department of Pediatrics, Dortcelik Children's Hospital, Bursa, Turkey
,
Berna Aktürk 
5   Department of Pediatrics, Bursa City Hospital, Bursa, Turkey
,
Özlem Gül Kırkas 
6   Division of Pediatric Hematology and Oncology, Department of Pediatrics, Dortcelik Children's Hospital, Bursa, Turkey
,
Esra Koçkuzu 
7   Division of Pediatric Intensive Care Unit, Department of Pediatrics, Dortcelik Children's Hospital, Bursa, Turkey
,
Erbu Yarci 
8   Division of Neonatology, Department of Pediatrics, Dortcelik Children's Hospital, Bursa, Turkey
,
Sabit Sahin 
4   Department of Pediatrics, Dortcelik Children's Hospital, Bursa, Turkey
› Author Affiliations Funding None.
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Abstract

Objective In this article, we aimed to evaluate the clinical, laboratory, and radiological findings and outcomes of patients treated with corticosteroids and intravenous immunoglobulin (IVIG) with the multisystem inflammatory syndrome in children (MIS-C) in two centers in Bursa, Turkey.

Methods We retrospectively collected the clinical characteristics, laboratory results, and treatment outcomes of MIS-C cases treated in two centers from April 2020 to February 2021. Patients were compared both according to their clinical categorization and the place they were hospitalized in, as well as with studies published in the literature.

Results Fifty-six patients were included. Thirty-six (64.3%) were male with a mean age of 67.95 ± 50.87 months. Thirty patients (53.5%) were categorized as Kawasaki-like disease, 17 (30.3%) sepsis-like disease, and 9 (16%) were toxic shock syndrome (TSS). Admission symptoms were fever (100%), rash (71.4%), myalgia (69.6%), and abdominal pain (62.5%). Seventeen (30.3%) patients were hospitalized in pediatric intensive care unit. Elevated C-reactive protein levels, procalcitonin, erythrocyte sedimentation rate, D-dimer, and troponin were found in 100, 77, 84, 84, and 23.2% of the patients, respectively. Of all, 55 (98.2%) received IVIG, 54 (96.4%) corticosteroids, 56 (100%) antibiotic therapy, 22 (40%) albumin infusion, and 13 (23.2%) inotropic support. Fifty patients (89.3%) received low-molecular-weight heparin: enoxaparin, followed by acetylsalicylic acid treatment. Only one patient who was resistant to both IVIG and steroid treatment received Anakinra. One patient (1.7%) with TSS died within 1 hour of hospitalization.

Conclusion Combined use of IVIG and corticosteroids is an effective way of treatment in MIS-C patients resulting in low mortality.

Keywords

multisystem inflammatory syndrome - Kawasaki disease - toxic shock syndrome - sepsis - corticosteroids - intravenous immunoglobulin

Authors' Contributions

Concept: S.E.B.; E.T.; design: S.E.B., E.T.; supervision: E.T., H.A.; materials: S.E., B.A.; data collection and/or processing: S.E., B.A., E.K., E.Y., S.S.; analysis and/or interpretation: E.T.; literature review: S.E.B., E.T.; writing: S.E.B.; critical review: E.Y., E.K., S.S.


Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.




Publication History

Received: 09 December 2021

Accepted: 22 February 2022

Article published online:
17 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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