Pediatrik Multisistem İnflamatuvar Hastalıkta (MIS-C) Gastrointestinal Sistem Tutulumu: 47 Olgunun Tek Merkez Deneyimi

Yıl 2023, Cilt: 13 Sayı: 2, 270 - 276, 22.03.2023

Aylin Yücel Ozge Metin

https://doi.org/10.16899/jcm.1244076

Öz

Özet
Amaç: Pediatrik multisistem inflamatuvar hastalık (MIS-C), koronavirüs 2019 (COVID-19) pandemisi sırasında yeni tanımlanan, ateş, inflamasyon ve çoklu organ yetmezliği ile karakterize hiperinflamatuvar bir sendromdur. Başlıca klinik prezentasyonlardan birisi gastrointestinal sistem tutulumudur. Çalışmanın amacı, gastrointestinal sistem tutulumu olan MIS-C olgularına odaklanarak, gastrointestinal tablonun şiddetine göre klinik seyir ve sonucu değerlendirmektir.
Yöntem: Ekim 2020-Mart 2022 tarihleri arasında kliniğimizde gastrointestinal tutulumu olan 47 MIS-C hastasının retrospektif bir çalışmasını gerçekleştirdik. Hastalar gastrointestinal tutulumun şiddetine göre iki gruba ayrıldı. Gruplar demografik özellikler, gastrointestinal semptomlar, laboratuvar parametreleri, diğer sistem tutulumları, hastanede kalış süreleri, tedavi yöntemleri ve klinik sonuçlar açısından karşılaştırıldı.
Bulgular: Gastrointestinal sistem tutulumunun ciddiyetine göre olguların %44.7'si (n=21) hafif-orta, %55.3'ü (n=26) şiddetli idi. Başvuru anında en sık görülen gastrointestinal semptomlar karın ağrısı (%78.7), kusma (%59.6) ve bulantı (%55.3) idi. Olguların %29.8'inde transaminaz yüksekliği mevcuttu. En sık radyolojik bulgu asit (%36.2) ve pankreas ödemi (%27.7) idi. Akut pankreatit ile başvuran olgularda (n=9), yoğun bakıma yatış oranları (n=6) istatistiksel olarak anlamlı derecede yüksekti. Brain natriüretik peptid (p=0.020) ve d-dimer (p=0.032), şiddetli grupta, hafif-orta gruba göre istatistiksel olarak anlamlı derecede yüksekti.
Sonuç: Gastrointestinal tutulumu olan MIS-C olgularının önemli bir kısmında ciddi bulgular görülmektedir. Özellikle pankreatit ile başvuran olgularda daha ağır bir klinik seyir gözlenebilir. Bu nedenle gastrointestinal semptomlarla prezente olan hastalarda pankreatit açısından değerlendirme gereklidir.

Anahtar Kelimeler

Pediatrik multisistem inflamatuvar hastalık, gastrointestinal tutulum, pankreatit

Gastrointestinal System Involvement of Multisystem Inflammatory Syndrome in Children (MIS-C): A Single Center Experience of 47 cases

Öz

Abstract
Backgraound/Aims: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome which was newly described during the coronavirus disease 2019 (COVID-19) pandemic in children and characterized by fever, inflammation, multiorgan dysfunction. One of the major clinical presentation is gastrointestinal system involvement. The aim of the study is to evaluate the clinical course and outcome according to the severity of gastrointestinal presentation, focusing on MIS-C cases with gastrointestinal system involvement.
Methods: We performed a retrospective study of 47 MIS-C patients with gastrointestinal involvement in our clinic between October 2020 and March 2022. The patients were divided into two groups according to the severity of gastrointestinal involvement. The groups were compared in terms of demographic characteristics, gastrointestinal symptoms, laboratory parameters, other system involvement, length of hospital stay, treatment modalities, and clinical outcomes.
Results: According to the severity of gastrointestinal system involvement, 44.7% (n=21) of the cases were mild to moderate, 55.3% (n=26) were severe. The most common gastrointestinal symptoms at presentation were abdominal pain (78.7%), vomiting (59.6%), and nausea (55.3%). Transaminase elevation was present in 29.8% of the cases. The most common radiological findings were ascites (36.2%) and pancreatic edema (27.7%). In cases presenting with acute pancreatitis (n=9), intensive care unit admission rates (n=6) were statistically significantly higher. Brain natriuretic peptide (p=0.020) and d-dimer (p=0.032) were statistically significantly higher in the severe group than in the mild to moderate group.
Conclusions: In a significant part of the MIS-C cases with gastrointestinal involvement, severe findings is observed. Especially in cases presenting with pancreatitis, a more severe clinical course may be observed. Therefore, when managing patients presenting with gastrointestinal symptoms, the evaluation for pancreatitis is essential.

Anahtar Kelimeler

Multisystem inflammatory syndrome in children, gastrointestinal involvement, pancreatitis

Kaynakça

• 1- Patel JM. Multisystem Inflammatory Syndrome in Children (MIS‑C). Curr Allergy Asthma Rep 2022;22(5):53-60.
• 2- Santos MO, Goncalves LC, Silva PAN, et al. Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes. J Pediatr (Rio J) 2022;98(4):338-49.
• 3- Jimenez DG, Rodríguez-Belvís MV, Gonzalez PF, et al. COVID-19 Gastrointestinal Manifestations Are Independent Predictors of PICU Admission in Hospitalized Pediatric Patients. Pediatr Infect Dis J 2020;39(12):459-62.
• 4- Godfred-Cato S, Bryant B, Leung J, et al. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020;69(32):1074-80.
• 5- Genceli M, Akcan Metin O, Erdogan KN, et al. Clinical and Laboratory Evaluations of Patients Diagnosed as Having Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 in Children: A Single Center Experience from Konya. J Pediatr Infect Dis 2023;18(1):17-24.
• 6- Morinville VD, Husain SZ, Bai H, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012;55(3):261-5.
• 7- Vecchio AL, Garazzino S, Smarrazzo A, et al. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021;4(12):e2139974.
• 8- Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children (Basel) 2020;7(7):69.
• 9- Gomez IJA, Lopez PP, Duque DC, et al. Abdominal manifestation of multisystemic inflammatory syndrome in children. J Pediatr Surg Case Rep 2021;74:102042.
• 10- Acharyya BC, Dutta M, Meur S, Das D, Acharyya S. Acute Pancreatitis in COVID-19-associated Multisystem Inflammatory Syndrome of Children-A Single Center Experience. JPGN Rep 2021;3(1):e150.
• 11- Sahn B, Eze OP, Edelman MC, et al. Features of Intestinal Disease Associated With COVID-Related Multisystem Inflammatory Syndrome in Children. J Pediatr Gastroenterol Nutr 2021;72(3):384-7.
• 12- Abrams JY, Godfred-Cato SE, Oster ME, et al. Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. J Pediatr 2020;226:45-54.
• 13- Sayed IA, Bhalala U, Strom L, et al. Gastrointestinal Manifestations in Hospitalized Children With Acute SARS-CoV-2 Infection and Multisystem Inflammatory Condition: An Analysis of the VIRUS COVID-19 Registry. Pediatr Infect Dis J 2022;41(9):751-8.
• 14- Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev 2021;38:51-7.
• 15- Cantor A, Miller J, Zachariah P, DaSilva B, Margolis K, Martinez M. Acute hepatitis is a prominent presentation of the multisystem inflammatory syndrome in children: a single-center report. Hepatology 2020;72(5):1522-27.
• 16- Giannattasio A, Maglione M, D’Anna C, et al. Liver and Pancreatic Involvement in Children with Multisystem Inflammatory Syndrome Related to SARS-CoV-2: A Monocentric Study. Children (Basel) 2022;9(4):575.
• 17- Hameed S, Elbaaly H, Reid CEL, et al. Spectrum of Imaging Findings at Chest Radiography, US, CT, and MRI in Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Radiology 2021;298(1):E1-E10.
• 18- Ucan B, Kaynak Sahap S, Cınar HG, et al. Multisystem inflammatory syndrome in children associated with SARS-CoV-2: extracardiac radiological findings. Br J Radiol 2022;95(1129):20210570.
• 19- Ilieva E, Kostadinova V, Tzotcheva I, Rimpova N, Paskaleva Y, Lazova S. Abdominal and Thoracic Imaging Features in Children with MIS-C. Gastroenterol Insights 2022;13(4):313-25.
• 20- Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreas May Cause Pancreatic Damage After SARS-CoV-2 Infection. Clin Gastroenterol Hepatol 2020;18(9):2128-30.
• 21- Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS‐CoV2 may play a role in the respiratory failure of COVID‐19 patients. J Med Virol 2020;92(6):552-5.
• 22- Deffner F, Scharr M, Klingenstein S, et al. Histological Evidence for the Enteric Nervous System and the Choroid Plexus as Alternative Routes of Neuroinvasion by SARS-CoV2. Front Neuroanat 2020;14:596439.
• 23- Alkan G, Sert A, Tuter Oz SK, Emiroglu M, Yılmaz R. MIS-C Clinical features and outcome of MIS-C patients: an experience from Central Anatolia. Clin Rheumatol 2021; 40(10):4179-89.