Multisystem Inflammatory Syndrome in Children” (MIS-C) after COVID-19 infection in the Metropolitan Area Nuremberg-Erlangen with a case of MIS-C like disease following SARS-CoV-2 mRNA vaccination

 

Background Multisystemic inflammatory syndrome in children (MIS-C) is a rare autoimmune reaction that occurs after a latency period following SARS-CoV-2 infection. Its clinical symptoms are similar to the Kawasaki disease including hyperinflammation, gastrointestinal, cardiac, respiratory, and neurological symptoms. Here, we aimed to investigate the incidence, therapeutical procedure and outcome of MIS-C patients in the metropolitan area of Nuremberg-Erlangen, comprising 3,6 million habitants. Further, we report patient with MIS-C with predominating gastrointestinal symptoms associated with SARS-CoV2 mRNA vaccination.

Material and Methods Clinical reports were screened for MIS-C in all Children Hospitals in the metropolitan area Nuremberg-Erlangen comprising 3,6 million habitants within the time period 01/2021 -12/2022. Symptoms, therapies, and outcomes are presented.

Results We identified 10 patients with MIS-C, at an average of 5,9 weeks after PCR confirmed COVID-19 infection. Mean age was 11. Symptoms comprised fever (n=10), a rash (n=6), bilateral non-purulent conjunctivitis (n=5), and urticaria(n=2). At the time of presentation range of C-reactive Protein was 4,13 mg/dl to 28mg/dl; PCT in 6 patients (1,92 ng/ml to 21,5ng/ml). 2 patients displayed leukocytosis and 2 leukopenia. All patients received IVIGs. 8 patients received steroids for 4-6 weeks, 4 received ASS. In addition, we report a 12-year-old patient who presented with MIS-C, several days after his second mRNA COVID-19 vaccination. Clinically he presented with polyserositis, severe gastrointestinal symptoms and consequently a Manifestation in multiorgan failure. IgG-Antibodies against spike proteins of SARS-CoV-2 were detected, indicating a successful vaccination, while SARS-CoV-2 Nucleocapsid protein antibodies were negative. Immunosuppression with steroids was initiated. Due to side effects, treatment with steroids and later interleukin 1 receptor antagonists was finally continued with Tacrolimus and Mycophenolic acid leading to improvement and discharge after 79Days. Several autoantibodies against G-protein coupled receptors (GPCR-AAb), previously associated with Long-COVID disease, were detected in a cardiomyocyte bioassay. Follow-up of the patient showed him (2/8/12 weeks) in good condition. AGPCR-AAb remained negative. Therapy was expanded to Omega-3-acid ethyl esters intending to lower risk for autoimmune relapse [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20].

Conclusion SARS CoV-2 virus exerts multiorgan manifestations due to hyperinflammatory immunological processes. Within two years of the ongoing COVID-19 pandemic within the metropolitan area Nuremberg-Erlangen, we identified ten patients with COVID induced MIS-C, as well as one patient with mRNA vaccination associated MIS-C. Due to the severity of MIS-C, early detection and intervention is warranted. Despite lower in incidence, it developed a serious condition and must be taken into account after vaccination in children without preceding COVID infection.

Publication History

Article published online:
06 June 2023

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