Multisystem inflammatory syndrome in children associated with COVID‐19 in 101 cases from Turkey (Turk‐MISC study)
Authors: Yilmaz Ciftdogan Dilek , Ekemen Keles Yildiz , Karbuz Adem , Cetin Benhur Sirvan , Elmas Bozdemir Sefika , Kepenekli Kadayifci Eda , Metin Akcan Ozge , Ozer Arife , Erat Tugba , Sutcu Murat , Buyukcam Ayse , Belet Nursen , Erdeniz Emine Hafize , Dalgic Karabulut Nazan , Hancerli Torun Selda , Oncel Selim , Orbak Zerrin , Turel Ozden , Gayretli Aydin Zeynep Gokce , Kilic Omer , Yahsi Aysun , Kara Aksay Ahu , Ergenc Zeynep , Petmezci Mey Talip , Oflaz Mehmet Burhan , Sarikaya Remzi , Otar Yener Gülcin , Ozen Seval , Gul Doruk , Arslan Gazi , Kara Soner Sertan , Demirkol Demet , Yazici Ozkaya Pinar , Yozgat Yilmaz , Varan Celal , Kara Manolya , Arga Gul , Yakut Nurhayat , Kilic Ahmet Osman , Cakici Ozlem , Kucuk Mehmet , Kaba Ozge , Karaoglu Asrak Hatice , Bursal Duramaz Burcu , Dalkiran Tahir , Berna Anil Ayse , Turgut Mehmet , Karapinar Bulent , Somer Ayper , Elmali Ferhan , Dinleyici Ener Cagri , Ciftci Ergin , Kara Ates 
Published: February 2022

Aim

Multisystem inflammatory syndrome in children (MIS‐C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS‐C in 25 different hospitals in Turkey.

Methods

The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.

Results

The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6–9.3); 51 (50.5%) were boys. Reverse‐transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS‐CoV‐2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C‐reactive protein (in 101 patients, median 165 mg/L; range 112–228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30–84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58–20.2) were elevated. Thirty‐eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.

Conclusion

The clinical spectrum of MIS‐C is broad, but clinicians should consider MIS‐C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS‐C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS‐C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS‐C. Prompt diagnosis and prompt treatment are essential for optimal management.