Skip to main content

Table 1 Clinical, para clinical and therapeutic data in 10 patients with Pediatric Inflammatory Multisystem Syndrome (PIMS) Associated with SARS -CoV-2

From: Clinical characteristics of 10 children with a pediatric inflammatory multisystem syndrome associated with COVID-19 in Iran

Number of case, age, sex, date of admission COVID-19 test First presentation symptoms and signs Ongoing presentation Abdomino pelvic Ultrasonography Chest imaging Echocardiography Laboratory data at admission Ongoing laboratory data treatments Total admission days, PICU stay, Out come First impression
Case 1: 12 years old boy,
28 march
Covid-19 RT- PCR: positive fever and chills, rash, diarrhea, fatigue, toxic appearance Second day: respiratory distress, heart and respiratory failure   Chest CT-scan: patchy ground glass opacity and interlobar septal thickening First day: mild MR, Mild TR, mild diastolic dysfunction, LVEF 50%,
Second day: moderate MR and TR, moderate diastolic dysfunction LVEF 30%
CBC: WBC: 8.7, N: 90, L: 10, Hb: 9.5, Plt: 75, CRP: 1+, ESR: 32, urea: 75, Cr: 2.5, AST: 62, ALT: 30, UA: Pro: 1+, WBC: many, RBC: 10–12
ABG: PH: 7.2, Hco3: 11.8, Pco2: 30, Po2: 32
Cr: 3.2, urea: 126,
D. dimer: 6888, CRP: 50
Vasoactives, Oseltamivir, meropenem, vancomycin, hydroxychloroquine, Kaletra, IVIG 1 g/kg, hydrocortisone 2 mg/kg/dose, packed cell Total: 3 days
ICU: 3 days
COVID-19 infection
Case 2:
5 years old girl, 8 April
COVID-19 RT-PCR positive Fever, vomiting, diarrhea and skin rash, cough and otalgia, conjunctivitis, Loss of appetite 3 to 5 days after admission: Tachypnea, drowsiness, generalized edema, headache, myalgia, pharyngeal congestion, purulent conjunctivitis, Abdominal pain mild to moderate free fluid in abdomen and bilateral mild to moderate plural effusion Normal CT-scan at admission.
But on day 5, bilateral plural effusion and patchy infiltration, ground glass apearance
mild TR, trivial MR, normal coronary arteries on 2 occasion CBC: WBC: 8.1, N: 60, Hb: 10,
, Plt: 150,
ESR: 71, CRP:28, Alb: 2.6
CBC: WBC: 6.6, N: 74, L: 20, Hb: 7.4, Plt: 86, ESR: 28, CRP: 23,
Alb: 2.2, total protein: 4
Vitamin D: 15
Hydroxychloroquine, Azithromycin, Ceftriaxone, changed to meropenem,, IVIG 1gr/kg, Albumin, Red Packed cell Total: 13
Alive, without sequel
Case 3: 13 months old boy, 13 April COVID-19 RT-PCR positive Fever, generalized erythematous patches, papule and some target shape lesion on edematous base 3 days after admission,
Respiratory distress, decrease spo2: 84% in ambient room and generalized edema
mild intra-abdominal fluid at admission: Normal chest CT-scan.
At day 3: Chest CT-scan:
bilateral plural effusion, basilar patchy infiltration and reverse halo sign
Mild TR, mild MR and normal coronary arties on 2 occasion CBC: WBC: 8.2, N: 65, Hb: 10.8, PLT: 189, Alb: 3.4
ESR: 54, CRP: 96
day 3: CBC, WBC: 14.5, N: 58, L: 29, Hb: 7.5, Plt: 141
ESR: 60, CRP: 26, Alb: 2.2,
hydroxychloroquine, Ceftriaxone, changed to meropenem, Vancomycin, IVIG 1gr/kg, Albumin, Red Packed cell Total: 8
PICU: 2 days,
Alive, complete improvement without sequel
Acute hemorrhagic edema of infancy
Case 4: 10 years old girl, 27 April COVID-19 IgG: positive Fever, itching skin rash, maculopapular and target shape rashes with more accumulation around neck and trunk and axilla cough, abdominal pain, oliguria, bilateral non purulent conjunctivitis, hypotension and toxic appearance Generalized edema, right leg edema and sever pain,
mild plural effusion
Urinary system ultrasonography was normal, color Doppler ultrasonography of lower limbs veins were normal CXR and Chest CT-scan before admission: NL
Chest CT-scan at day 4: COVID-19 compatible changes and mild bilateral plural effusion
mild MR, mild TR, Mild PI, EF: 60–64% in 3 occasion CBC:
WBC: 9, N: 69, L: 10,
Hb: 7.5, Band: 12, Plt: 130, ESR: 30, CRP: 36,
Urea: 78, cr: 2.3,, D Dimer: 6556
Alb: 2
Third day: CBC:
WBC: 13.9, N: 87
L: 6
Hb: 9.6
Plt: 211
meropenem, clindamicine, vancomicine,
vasoactives, IVIG 1 g/kg, red packed cell, albumin, enoxaparine, Vitamin D, zinc
Total: 11
Alive, complete improvement without sequel
Toxic shock syndrome
Case 5: 14 months old boy, 3 May COVID-19 RT-PCR negative, IgM: positive fever, irritability, macoulopapolar erythematous rashes, edema of hands and feet, Cracked and erythematous lips, erythematous tongue and bilateral non purulent conjunctivitis Irritability, abdominal distension, giant coronary aneurysm Liver span: 117 mm, spleen: 98 mm, greater than normal, mild intra-abdominal fluid, mild bilateral plural effusion First day: CXR normal, Chest CT-scan showed non-significant changes
Day 4: chest CT-scan: non-significant changes
First day: normal coronary arteries, minimal right Pleural effusion (5 mm), minimal MR, good EF CBC: WBC: 22, N: 83, L: 5, 6, Band: 5, Hb: 10.6, plt: 197, ESR: 65, CRP: 38, Na: 129, AST: 200, ALT: 197, Alb: 2.3,
PTT: 50, PT: 18, INR: 2
Day 4:
WBC 21.8, N: 79, L: 15, Hb: 8.7, Plt: 224,
Alb: 3.2, AST: 57, ALT: 55, PT: 14.8, PTT: 42, INR: 1.3,
Day 14: CBC: WBC: 25.7 N: 38, L: 44, Mono: 17, Hb: 11.6, Plt: 1168
CRP: 10.9, ESR: 25
IVIG 2 g/kg/day × 2, Aspirin, hydroxychloroquine, zinc, Vitamin D,
Cefotaxim, changeed to meropenem and vancomicine. Albumin, red packed cell, methyl prednisolone 2 mg/kg/day, vasoactives, heparin, warfarin, infliximab
Total: 24
PICU: 20
Alive, Giant coronary arteries aneurysm
Kawasaki disease
Case 6: 6.5 years old boy,
4 May
COVID-19 RT-PCR negative, COVID-19 IgG positive fever, anorexia abdominal pain, vomiting, loose defecation, erythematous rash around feet, hands, trunk and perioral, periorbital edema, erythema of oropharynx, right TM erythema At day 2: dyspnea, repertory distress, spo2 87%, mild abdominal distension, irritability, anasarca edema spleen: 117 mm, more than normal with normal parenchymal echo, free interloop fluid, sub hepatic and sub splenic, several reactive lymph nodes 15*7 mm in para aorta and peripancreatic At admission: Chest CT, non-significant changes for COVID-19
At day 4: Chest CT-scan bilateral opacities compatible with COVID-19
Day 2: minimal TR Day 4: mild TR, trivial MR CBC: WBC: 4.7
N: 77,
L: 14, band: 3, Hb: 10, Plt: 121, ESR: 48, CRP: 45,
UA: blood: trace, WBC: 8–10,
CBC: WBC: 6.93
Hb: 7.8
Plt: 73
L: 14
N: 80
Alb: 2.3
CRP: 39
ESR: 58
Ceftriaxone, Vancomycin, Meropenem, hydroxychloroquine, packed cell, Albumin Total: 11
Alive, without sequel
Case 7: 7.5 year old girl 4 May COVID-19 RT-PCR negative fever, irritability, abdominal pain, myalgia, vomiting, diarrhea and generalized erythematous maculopapular and patches Facial edema, tachypnea and tachycardia developed and the patient got toxic with gallop in heart auscultation Normal Admission Chest CT: NL
CXR: at day 3: bilateral mild Ground Glass opacity
Day 3: Mod MR, TR, low EF 50%, Dilated RV, LV: myocarditis
Day 7: moderate MR, mild Pleural effusion, low LVEF, lack of tapering, brightness in RCA and LAD compatible with KD and Myocarditis
CBC: WBC: 9.8, N: 89, L: 10,
Vitamin D: 4 ng/ml
ALT: 69
WBC: 13.3
Hb: 7.5,
Plt: 213
N: 85
L: 10
Alb: 1.9,
ESR: 73, CRP: 35
Urea: 72 Cr: 1.1
Ceftriaxone, changed to Vancomycin, Meropenem, hydroxychloroquine, Zinc, Vitamin D, magnesium sulfate, packed cell, Albumin,
IVIg: 2 g/kg
Total: 12
Alive, without sequel
case 8: 20 months old boy, 9 may COVID-19 RT-PCR negative, COVID-19 IgG, IgM negative Fever, coryza, vomiting diarrhea, abdominal pain, irritability during urination and loss of appetite, erythematous papule in 2 centimeter diameter in the forehead, erythema of oropharynx tachypnea with unilateral tongue swelling and drooling, with discrete ulcers under the tongue Normal Chest CT: bilateral ground opacity compatible with COVID-19 lack of tapering in RCA and LAD, Mild dilatation of LA, LMCA: 3.7 mm, RCA: 2.2, LAD: 2.2, perivascular brightness around LAD, moderate MR, diastolic dysfunction WBC: 52.5, N: 80, L: 10, band: 4, Hb: 9.5, Plt: 932, ESR: 100, CRP: 1+
SE: WBC: 4–5, RBC: 2–3
ABG: PH: 7.33, Pco2: 37, HCO3: 19.9, PO2: 71,
Alb: 2.5
Ceftriaxone changed to clindamycin and Meropenem, hydroxychloroquine, Zinc, Vitamin D, IVIG 2 g/ kg, aspirin 80 mg/kg/day Total: 11
Alive, without sequel
Case 9: 7 years old boy, 23 may COVID-19 IgM and IgG and RT.PCR negative Fever with epigastric pain which shift to Right Lower Quadrant, nausea, vomiting ill, abdominal distension and recurrent vomiting Reactive lymph node, max diameter 6 mm, fat stranding in Right Lower Quadrant and free inter loop fluid Chest CT: sub plural atelectasis, mild bilateral pleural effusion, some nodular like lesions in both inferior lobes of lungs compatible with COVID-19 NL CBC: WBC: 24,000, L: 6%, N: 90%, band: 4%,
Hb: 11, Plt: 356, ESR: 72, CRP: 2+
Day 2: CBC: WBC: 13.5, N: 77, L: 10, Mono: 11,
Hb: 10.3, Plt: 347, ESR: 90, CRP: 25
Alb: 3.2
Meronidazole, Ceftriaxine changed to meropenem, hydroxychloroquine, Vitamin D, Zinc Total: 6 Appendicitis
Case 10: 18 months old girl
13 June
RT- PCR COVID-19 positive Fever and status epilepticus Second day: ill and lethargic, maculopapolar blench able rash, tachypnea   CXR: nl
Chest CT in 2 occasion: bilateral nonspecific opacity in inferior lobes
Normal CBC: WBC: 8.5, N: 80%, L: 14%, Hb: 11.8, PLT: 160
ESR: 15, CRP: 16
Alb: 2.3
WBC: 1.88, N: 34, L: 59, M: 5, Hb: 10.2, plt: 103
CRP: 3
Alb: 2.5
Meropenem, clindamycine, phenobarbital, hydroxychloroquine, Vitamin D
Albumin, IVIG, 1 g/kg, Zinc
Total: 12
Prolonged febrile seizure
  1. ABG Arterial blood gas, Alb Albumin, grams per deciliter, Alt Alanine aminotransferase, units per liter, AST Aspartate aminotransferase, units per liter, CBC Complete blood count, Chest CT-scan Chest computed tomography scan, COVID-19 Coronavirus disease 2019, Cr Creatinine, milligrams per deciliter, CRP C reactive protein, milligram per liter, CXR Chest roentgenogramD-dimer ng/mL, increased level > 500, ESR Erythrocyte sedimentation rate, millimeters per hour, Hb Hemoglobin, grams per deciliter, IgM Immunoglobulin MIgG Immunoglobulin G, INR International normalized ration, IVIG Intravenous immunoglobulin, KD Kawasaki disease, L Lymphocyte, %, LAD Left anterior descending artery, LMCA Left main coronary artery, LVEF Left ventricular ejection fraction, Mono Monocyte, %, MR Mitral regurgitation, NA Not assessed, N Neutrophil%, Na Sodium, mill equivalents per liter, NL Normal, Plt Platelet, × 109/Liter, PICU Pediatric intensive care unit, Pro Protein, PT Prothrombin time, seconds, PTT Partial thromboplastin time, seconds, RCA Right coronary artery, RT-PCR Reverse transcription polymerase chain reaction, SARS-CoV-2 Acute respiratory syndrome coronavirus 2, TR Tricuspid regurgitation, Total protein Grams per deciliter, Urea Milligrams per deciliter, Vitamin D, ng/mL, WBC White blood cell, × 109/Liter