195 - CLINICAL, BIOLOGICAL AND CARDIAC CHARACTERISTICS OF PEDIATRIC INFLAMMATORY MULTISYTEMIC SYNDROME: A SINGLE CENTER EXPERIENCE

Background: Pediatric inflammatory multisystemic syndrome (PIMS) is defined by a hyperinflammatory post-infectious disorder associated with SARS-COV 2. Its severity is due to the cardiac involvement. Early diagnosis and treatment can prevent cardiac complication in particular myocarditis. In this study, we aimed to describe  clinical, biological, and therapeutic features of PIMS, and report the prevalence of cardiac involvement.

Methods: We conducted a case series study of pediatrics patient with PIMS admitted to the pediatric rheumatology department of A. Harouchi Mother and Child Hospital, CHU Ibn Rochd, a tertiary care hospital at Casablanca, Morocco. Two period were identified: a retrospective period between March 2020 and December 2020 and a prospective one between January 2021 and December 2022. The diagnosis of PIMS was based on prolonged fever, increased inflammatory markers and positive Covid 19 serology with or without positive polymerase chain reaction. One patient with a suggestive picture of PIMS was excluded in the absence of Covid 19 proof.

Results: Twenty-nine cases were collected over two years, and their distribution according to year of recruitment is shown in Figure 1, with a male predominancy (sex ratio: 1.3). The mean age was 4 years (8 months to 15 years). All patients had a long-lasting fever, cheilitis in 87% of cases, bilateral conjunctival injection in 68%, skin rash in 62%, followed by gastrointestinal symptoms in 54.2%.  The rarest clinical manifestations were extremity involvement in 31% and cervical adenopathy in 25%. Increased inflammatory markers was reported in all patients, and lymphopenia was observed in 31 % of cases. Elevated levels of cardiac biomarkers were observed in 08 patients with high levels of Pro-BNP. No patient required intensive care unit hospitalization. The following cardiac complications were reported: myocarditis in 29% of cases and coronary dilatation in 14.2%, and one case of aneurysm in 3.4%.  All patients were treated with IVIG combined with intravenous corticosteroid and aspirin at an antiplatelet dose. Apyrexia was achieved on the first day of treatment in 89% of cases, there was a complete recovery from cardiac involvement, except the case of aneurysm.  

Conclusion: The PIMS entity was firstly described during the Covid 19 pandemic. In our series, as described in the literature, gastrointestinal symptoms and lymphopenia were present, and cardiac involvement affected 46.6% of cases, myocarditis remaining the most frequent.  The combination of IVIG and corticosteroid was effective. Early diagnosis and treatment can reduce inflammation and heal cardiac damages.