Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children (MIS-C) that is related to COVID-19: a single center experience of 44 cases

Abstract

Until recently, the clinical course of coronavirus disease 2019 (COVID-19) in children has been reported to be largely mild.1,2 Recently, it has become evident that a subset of children exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can become critically ill with a condition now referred to as multisystem inflammatory syndrome in children (MIS-C), characterized by systemic hyperinflammation with fever and multi-system organ dysfunction.3 Gastrointestinal symptoms are increasingly recognized to be associated with the presentation of MIS-C, potentially confusing the diagnosis of MIS-C with other common, less toxic gastrointestinal infections and even inflammatory bowel disease. In the first published correspondence describing MIS-C in eight patients from the United Kingdom, 100% presented with GI symptoms.4 Similarly 6 of 10 patients from an Italian cohort had GI issues.5 This is In contrast to adults, who most commonly present with respiratory symptoms, and report GI symptoms in <10-15% of cases.6,7 We examined whether similar presentations and prevalence extended to our comparatively larger U.S. cohort of 44 patients (<21 years old) with MIS-C.