542 - SARS CoV-2-Associated Multisystem Inflammatory Syndrome of Children (MIS-C) in the Washington DC Metropolitan Region

Presenting Author(s)

Roberta L. DeBiasi

Chief and Professor
Children's National Hospital/The George Washington University School of Medicine and Health Sciences
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KS

Karen L. Smith

Chief, Division of Hospitalist Medicine
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Michael Bell

Professor
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CB

Charles Berul

Professor and Attending Physician
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EA

Emily Ansusinha

Lead Clinical Research Coordinator
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VB

Vanessa Bundy

Assistant Profesor, Attending
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MD

Meghan Delaney

Division Chief
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YD

Yaser Diab

Attending Hematologist
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Andrea Hahn

Assistant Professor of Pediatrics
Children's National Health System
Washington, DC
Disclosure: Johnson and Johnson (Consultant)
Rana F. Hamdy

Associate Professor of Pediatrics
Childrens National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Benjamin Hanisch

Assistant Professor
Children’s National Hospital, Washington, DC, USA
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Nada Harik

Associate Professor
Children’s National Hospital/ GWU School of Medicine
Washington, DC
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AH

Ashraf S. Harahsheh

M.D., F.A.C.C., F.A.A.P.
Children's National Hospital/ The George Washington University School of Medicine & Health Sciences
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JH

Jessica Herstek

Attending Physician
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JK

Jaclyn Kline

Assistant Profesor, Attending
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Wei Li A. Koay

Infectious Diseases Attending
Children’s National Health System
Washington, DC
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AK

Anita Krishnan

Associate Director, Echocardiography
Children's National Medical Center
Potomac, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BJ

Barbara A. Jantausch

Professor and Attending Physician
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SM

Suvankar Majumdar

Attending Physician
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KP

Kavita Parikh

Associate Professor of Pediatrics
Children's National Hospital
Washington DC, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JP

Jay Pershad

Chief
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TR

Tova Ronis

Pediatric Rheumatologist
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ES

Eleanor D. Sadler

Clinical Pharmacy Specialist, Infectious DIseases
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HS

Hemant Sharma

Professor and Attending Physician
Children's National Hospital
Washiington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Matthew P. Sharron

Attending Physician
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HS

Hemalatha Srinivasalu

Attending Physician, Pediatric Rheumatology; Assistant Professor of Pediatrics
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Sangeeta Sule

Chief and Attending Physician
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EW

Elizabeth Wells

Associate Professor, Department of Neurology and Pediatrics
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DW

David Wessel

Chief Medical Officer
Children's National Hospital
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background:

Background: Multi-system Inflammatory Syndrome of Children (MIS-C) has recently emerged internationally as a serious inflammatory complication of SARS-CoV-2 infection with significant morbidity for the pediatric population.

Methods: This observational retrospective cohort study includes 33 children meeting CDC criteria for MIS-C treated between March 15 and June 17, 2020 at Children’s National Hospital in Washington DC. Clinical and demographic data were extracted from medical records and are summarized.

Results: Of 33 hospitalized MIS-C patients, 42% were critically ill, and 58% were non-critically ill. The median age was 8.9 years (0.7-18.7 years). More males (58 %) than females (43 %) were represented in the MIS-C cohort. The majority (75%) of children had no underlying medical condition. Criteria for incomplete or complete Kawasaki Disease (KD) were present in 39% of patients, while an additional 9% had some features of KD. However the remaining 52% of MIS-C patients presented with other sub-phenotypes including prominent severe abdominal pain and/or nonspecific multiorgan dysfunction. 30% presented with shock requiring volume and/or inotropic support. SARS-CoV-2 antibodies were present in 61% of patients. Virus was detectable by PCR in 36% of patients. At the time of initial evaluation, 39% (13/33) of children had identified cardiac abnormalities including myocardial dysfunction (5/33; 15%), coronary ectasia (4/33; 12%), coronary aneurysm (3/33; 9%), or pericardial effusion 5/33; 15%) either alone or in combination. Cytokine profiling identified elevation of several cytokines in this cohort, including IL-6. Treatment has included intravenous immunoglobulin, aspirin, anakinra and other immunomodulatory therapies, with overall rapid response to therapy. No deaths have occurred.

Conclusion: The emergence of MIS-C late in the surge of SARS-CoV-2 circulation in the Washington DC metropolitan region has added to the already significant burden of hospitalized and critically ill children in our region. A significant percentage of these children present with cardiac dysfunction and abnormalities, whether or not with KD features at presentation. Detailed characterization of immune responses and long term outcome of these patients is a priority.