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AB1235 (2022)
MULTISYSTEM INFLAMMATORY DISEASE IN CHILDREN (MIS-C) IN SINGAPORE CHILDREN: ARE WE DIFFERENT?
L. Das1, K. L. Teh1, X. Gao1, T. Arkachaisri1,2
1KK Women’s and Children’s Hospital, Rheumatology and Immunology, Singapore, Singapore
2Duke-NUS Medical School, Rheumatology and Immunology, Singapore, Singapore

Background: Multisystem Inflammatory Syndrome in Children (MISC) is a hyper-inflammatory state with similarities to Kawasaki Disease, 4 to 6 weeks after Covid-19 infection 1 . Literature describes a 11:1 Relative Risk for Asian children versus Caucasians 2 . Since the start of the pandemic, 17,699 children under 12 years were infected with Covid-19 3 .


Objectives: To describe presentation and short term outcomes, for a cohort of children with MIS-C at the sole Children’s Hospital in Singapore.


Methods: Demographic and clinical/lab data were collected from children diagnosed with MIS-C accrording to the WHO criteria 4 at KK Woman’s and Children’s Hospital, Singapore. Nonparametric descriptive statistics were used to describe and analyse data.


Results: Eleven patients were diagnosed with MIS-C between October 2021 and Jan 2022. Seven (64%) were male and 4 (36%) were Chinese, with median age at presentation was 8.08 years (IQR 4.54 - 9.79). All patients had positive COVID-19 serology at the time of diagnosis. Median duration of fever prior to diagnosis was 5 days (IQR 4 - 5); Nine (82%) had gastrointestinal symptoms and median number of Kawasaki Disease (KD) features were 2 (IQR 2 - 3.5); common manifestations were conjunctivitis (90%), red lips (55%) and rash (36%). Of note, 8 (70%) patients had KD type peeling on follow-up. No BCGitis was found during acute phase. Seven (64%) were admitted to higher dependency care.

Table 1 , all patient received IVIG and IV steroids; 6 (55%) as pulse (30mg/kg/day) therapy. Patient 8, additionally received Anakinra. Median duration of admission was 6 days (IQR 5-13). One patient developed complications post therapy and was re-admitted to hospital for hematochezia. Treatment involved stopping Enoxaparin and Prednisone. Aspirin was resumed as soon as bleeding ceased. Laboratory characteristics and outcomes are denoted in Table 1 . All patients had a monophasic course during the median of 10 weeks (IQR 8 - 11.5) of follow-up.

No Age (yr ) GI symptoms KD features Hemoglobin (g/DL ) Absolute Lymphocyte (10x9/L ) Platelet (10x9/L ) CRP (mg/L ) D-Dimer (mg/L FEU ) Ferritin (ug/L ) Enoxaparin started Peeling Abnormal echo
1 10 YES 2 12.2 0.23 67 173.2 32 3179.1 YES YES YES
2 11 NO 2 14.8 1 166 94.9 2.51 350 NO YES YES
3 4.25 YES 2 10.4 1.02 241 134.6 6.05 277.2 YES NO YES
4 7.67 YES 5 11 0.41 102 250.6 9.32 3607.6 YES YES NO
5 8.58 YES 4 11.4 0.56 93 105.6 1.31 846.6 NO YES NO
6 4.58 YES 2 10.3 3.09 198 137.4 1.87 291 NO NO NO
7 9.58 YES 3 12.2 1.31 119 184 2.51 244.3 NO YES NO
8 4.5 YES 4 11.9 0.45 102 181.8 11.12 1798.4 YES NO YES
9 11 YES 1 10.1 1.23 59 74.2 4.53 1445.8 YES YES NO
10 3.42 NO 2 9.1 1.09 138 153.9 8.66 609.4 YES YES NO
11 8.08 YES 2 11.4 1.25 101 66.8 1.31 521.8 NO YES YES

Conclusion: 1.Asian prevalence of MIS-C is not as high as that reported from the West. Similarities in presentation as to age and gender were noted.

2.Most of our MIS-c patients developed periungual peeling at follow up, similarly to Kawasaki Disease.

3.Different from our typical KD population, no BCG site inflammation was found.


REFERENCES:

[1]Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA . 2021;325(11):1074-1087.

[2]Middelburg JG, Crijnen TEM, D’Antiga L, et al. Association of Ethnicity with Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2 Infection Frontiers in Pediatrics Oct 2021 Vol 9.

[3]Ang Qing, Number of children admitted for covid-19 at KKH doubles since December 2021. New Straits Times, 27 Jan 2022.

[4]World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief. 2020


Disclosure of Interests: None declared

Citation: , volume 81, supplement 1, year 2022, page 1729
Session: Paediatric rheumatology (Publication Only)