GI Issues in Kids With COVID-19 MIS-C May Muddy Diagnosis

— Pediatric multisystem inflammatory syndrome symptoms could mimic less toxic GI infections, IBD

Children and adolescents with COVID-19 who developed multisystem inflammatory syndrome (MIS-C) often exhibited marked gastrointestinal (GI) manifestations, sometimes confounding diagnosis by mimicking GI infections or inflammatory bowel disease (IBD), according to a recent case series.

In a chart review of 44 pediatric patients (ages 7 months to 20 years, 55% female) hospitalized for COVID-19-related MIS-C from April 18 to May 22, 2020, GI symptoms were prominent in 84.1% of cases and were commonly accompanied by fever (100%) and rash (70.5%), reported Kara Gross Margolis, MD, of Morgan Stanley Children’s Hospital at Columbia University Irving Medical Center in New York City, and colleagues.

However, unlike adult patients, only 25% of the pediatric patients in the case series required supplemental oxygen, and only one required intubation, they stated in Gastroenterology.

Some 30% had within the past 7 days visited an emergency department or urgent care center for less severe symptoms, such as fever and GI symptoms mimicking viral gastroenteritis, including nausea, vomiting, and diarrhea. No other systemic symptoms were evident.

Of the 27% of patients who had an infectious polymerase chain reaction panel performed on stool, none had an identified infection. The majority of cases at admission had markedly elevated inflammatory markers: erythrocyte sedimentation rate (ESR) median of 59 and C-reactive protein (CRP) median of 146.5. They also had mildly decreased albumin (median 3.7), and 52.3% had elevated transaminases. Just one patient had lipase elevated to more than three times the upper limit of normal.

MIS-C, a condition involving systemic hyper inflammation with fever and multisystem organ dysfunction similar to the symptomatic profile of Kawasaki disease, should, therefore, be considered in patients who present with prominent GI symptoms, and a history of recent SARS-CoV-2 exposure, according to the authors. Long-term follow-up of possible organ dysfunction may warrant surveillance for IBD, they added.

by Diana Swift, Contributing Writer, MEDPAGE TODAY

The study was supported by the NIH and the Department of Defense.
Margolis and co-authors, as well as Grossman, disclosed no relevant relationships with industry.

Primary Source
Source Reference:
 Miller J, et al “Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children (MIS-C) that is related to COVID-19: a single center experience of 44 cases” Gastroenterology 2020; DOI: 10.1053/j.gastro.2020.05.079.