MIS-C Treatment: Is glucocorticoid monotherapy enough for mild cases?

Autor: Sütçü M; Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Infectious Diseases, Istanbul, Turkey., Kara EM; Yeditepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey., Yıldız F; Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatrics, Istanbul, Turkey., Gül D; Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatrics, Istanbul, Turkey., Yıldız R; Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Department of Pediatric Emergency, Turkey., Yılmaz D; Yeditepe University Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey. Electronic address: md.duyguyilmaz@gmail.com., Atik F; Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Cardiology, Istanbul, Turkey., Özkaya O; Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2024 Sep; Vol. 83, pp. 95-100. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1016/j.ajem.2024.06.030
Abstrakt: Background: The effectiveness of using only glucocorticoids (GCs) in mild multisystem inflammatory syndrome (MIS-C) cases was compared with combined treatment [GCs + Intravenous immune globulin (IVIG)].
Methods: This retrospective cohort study was conducted between June 1, 2020, and June 1, 2022, in a tertiary care center in Istanbul, Turkey. Clinical and investigational data of the MIS-C patients were analyzed. The patients were divided into two groups: those who received only GCs and those who received the GCs + IVIG combination. The primary outcome focused on assessing the deterioration of the patient's clinical condition, the occurrence of shock, admission to the pediatric intensive care unit (PICU), and the need for additional immunosuppressive medication. Secondary outcomes included evaluating the course of cardiovascular and infection-related complications observed at the one-year follow-up.
Results: Ninety-seven MIS-C patients with a median age of 41 (3- 214) months were enrolled. Fifty-six (57.7%) patients were male. All the patients had fever at admission with a temperature of 39 °C (37.5 °C-40.1 °C). Thirty-two patients (33%) had cardiac findings on echocardiography [left ventricular dysfunction (n= 13, 13.5%), coronary artery involvement (n= 11, 11.3%), and dilation of cardiac cavities and/or increased cardiac muscle thickness (n= 8, 8.2%)]. Thirteen patients (13.5%) required intensive care. All patients received GCs [only GCs (group I; n= 65, 67%)], and 32 patients (33%) with severe manifestations and/or cardiac involvement received GCs + IVIG (group II). No mortality was observed. None of the patients had any complaints at the one-year follow-up, and all echocardiography findings were normal.
Conclusion: This study provides preliminary evidence that GC monotherapy is a safe treatment alternative for mild MIS-C cases without cardiac involvement.
Competing Interests: Declaration of competing interest No conflict of interest was declared by the authors.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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