Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 in Indian children: Pune experience

Bhakti Sarangi, Ajay Walimbe, Guruprasad Hassan Shankar, Jitendra S. Oswal, K. V. Sandeep Reddy, K. C. Prithvichandra


Background: Aim was to study the clinical profile, laboratory parameters and outcome of children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).

Methods: This is an observational study done in a PICU of a tertiary care teaching hospital in Pune conducted over seven months starting from 1st June to 31st December, 2020 and which included the children meeting the case definition of PIMS-TS.

Results: A total 25 children were included of which 13 (52%) were males. Median age was 7 years. Fever of short duration was present in all children and 23 (92%) had gastrointestinal symptoms. 21 (84%) had features of shock while myocardial dysfunction was seen in eight (32%) children. Kawasaki disease like features were present in seven (28%) while five (20%) showed coronary artery dilatation. All had neutrophilia and lymphopenia while 10 (40%) showed thrombocytopenia. Interleukin-6 levels, done in six, and were found to be raised in all. SARS-CoV-2 RT-PCR and IgG antibody were positive in two while only IgG was positive in 14 (56%) children. Seven required mechanical ventilation while eleven were managed with HFNO. 16 (64%) children received both IVIG and steroids, two (8%) children received only IVIG while seven (28%) received only steroids. Two children each additionally received Tocilizumab and infliximab. 24 (96%) children survived.

Conclusions: Fever, gastrointestinal symptoms and hypotensive shock were predominant features of PIMS-TS. 2/3rd of children had demonstrable SARS-CoV-2 antibodies. Cardiac dysfunction was seen in 1/3rd of the children. It is a life-threatening illness requiring critical interventions, multi-organ support and various immunomodulators.


IL-6, COVID-19, MIS-C, Kawasaki disease, Hyperinflammatory syndrome, Toxic shock syndrome

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Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical Features and Outcome of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-analysis. Indian Pediatr. 2020;57(9):820-26.

Sarangi B, Reddy VS, Oswal JS, Malshe N, Patil A, Chakraborty M, Lalwani S. Epidemiological and Clinical Characteristics of COVID-19 in Indian Children in the Initial Phase of the Pandemic. Indian Pediatr. 2020;57(10):914-7.

Rapid risk assessment: Paediatric inflammatory multisystem syndrome and SARS -CoV-2 infection in children. European Centre for Disease Prevention and Control. 2020. Available from: Accessed on August 31, 2020.

RCPCH. Guidance-Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Available from: Accessed on August 31, 2020.

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) Available from: Accessed on August 31, 2020

Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 Available from: Accessed on August 31, 2020.

McCrindle BW, Rowley AH, Newburger JW. Diagnosis, Treatment, and Long-term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017;135: e927-99.

McCrindle BW, Li JS, Minich LL. Pediatric Heart Network Investigators. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation. 2007;116:174-9.

Loomba RS, Villarreal E, Flores S. Covid-19 and Kawasaki syndrome: Should we really be surprised? Cardiology in the Young. Cambridge University Press; 2020;30:1059-60.

Yanagawa H, Nakamura Y, Ojima T, Yashiro M, Tanihara S, Oki I. Changes in epidemic patterns of Kawasaki disease in Japan. Pediatr Infect Dis J. 1999;18(1):64-6.

Son M. Pediatric inflammatory syndrome temporally related to covid-19. BMJ. 2020;369:m2123.

Chiotos K, Bassiri H, Behrens EM. Multisystem Inflammatory Syndrome in Children during the COVID-19 pandemic: a case series. J Pediatric Infect Dis Soc. 2020;9(3):393-8.

McCrindle BW, Manlhiot C. SARS-CoV-2-Related Inflammatory Multisystem Syndrome in Children: Different or Shared Etiology and Pathophysiology as Kawasaki Disease? JAMA. 2020;324(3):246-8.

Rowley AH, Baker SC, Orenstein JM, Shulman ST. Searching for the cause of Kawasaki disease--cytoplasmic inclusion bodies provide new insight. Nat Rev Microbiol. 2008;6(5):394-401.

Oudkerk M, Büller HR, Kuijpers D. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology. 2020;201629.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607-8.

Whittaker E, Bamford A, Kenny J. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;e2010369.

Celkan, T. Aplastic anemia presenting as hemophagocytic lymphohistiocytosis. Turk J Hematol. 2010;27(1):38-42.

Borlot F, Da Paz JA, Casella EB, Marques-Dias MJ. Acute hemorrhagic encephalomyelitis in childhood: Case report and literature review. J Pediatr Neurosci. 2011;6(1):48-51.

Ascenção BB, Gonçalves AC, Luís N. Epstein-Barr virus hemorrhagic meningoencephalitis: case report and review of the literature. J. Neurovirol. 2016;22(5):695-8.

Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features. Radiology. 2020;296(2):E119-20.

Dixon L, Varley J, Gontsarova A. COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia. Neurol Neuroimmunol Neuroinflamm. 2020;7(5):e789.

Ramcharan T, Nolan O, Lai CY. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020;1-11.

Toubiana J, Poirault C, Corsia A. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094.

Feldstein LR, Rose EB, Horwitz SM. Multisystem inflammatory syndrome in US children and adolescents. N Engl J Med. 2020;383:334-46.

Davies P, Evans C, Kanthimathinathan HK. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: A multicentre observational study. Lancet Child Adolesc Health. 2020;4(9):669-77.