Rare but serious post-COVID-19 complication in the young

May 27, 2021

A multidisciplinary team from MassGeneral Hospital for Children (MGHfC), Brigham and Women’s Hospital, and other institutions have identified the mechanism for how an extremely rare but serious post-COVID-19 complication develops in children and adolescents, according to a news release from Mass General.

Led by MGHfC Pediatric Pulmonologist Lael Yonker, MD, researchers determined that viral particles remaining in the gut long after an initial COVID-19 infection can travel into the bloodstream, instigating the condition called Multisystem Inflammatory Syndrome in Children (MIS-C).

The syndrome can occur several weeks after an initial infection; symptoms include high fever, abdominal pain, vomiting, diarrhea, rash, and extreme fatigue. The hyperinflammatory response and “cytokine storm” seen in MIS-C can lead to extensive damage in the heart, liver, and other organs.

Eighty percent of children hospitalized with MIS-C develop severe cardiac pathology and face a prolonged hospital stay and extensive recovery period. Current treatment strategies include an aggressive, long-term course of steroids and intravenous immunoglobulin.

MIS-C occurs in less than 1 percent of children with confirmed SARS-CoV-2 infection. As of May 3, 2021, the U.S. Centers for Disease Control and Prevention (CDC) reported 3,742 children diagnosed with MIS-C and 35 deaths. U.S. statistics are skewed heavily toward Latino and Black children, with a total of 63 percent in cases with race or ethnicity listed.

In their recent study published in the Journal of Clinical Investigation, which included 100 children (19 with MIS-C, 26 with COVID-19 and 55 healthy controls), the researchers provide insight into the mechanics of MIS-C and identify potential biomarkers for early disease detection, treatment and prevention. They also describe the successful treatment of a 17-month-old infant with MIS-C.

“When we realized that 95 percent of the children with MIS-C had SARS-CoV-2 viral particles in their stool but no or low levels of particles in their noses or throats, we investigated further and found that viral material lingering in the gut long after the first COVID-19 infection could lead to MIS-C,” says Yonker, lead author of the paper. The team hypothesized that SARS-CoV-2 viral particles found in the gastrointestinal tract of children move into the bloodstream, leading to the hyperinflammatory immune response characteristic of MIS-C. “This is the first study showing viral particles in the blood of MIS-C coinciding with the hyperinflammatory response,” says Yonker.

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