Multi-system Inflammatory Syndrome in Children in two private, urban, tertiary hospitals in Metro Manila, Philippines

Background: MIS-C is an infrequent, but serious complication encountered after acquiring COVID-19 illness in children. There is a lack of local data on MIS-C in the Philippines. Objective: To identify demographic data, co-morbidities, clinical manifestations, laboratory results, 2D-echocardiography findings, acute co-illnesses and complications, treatment, and outcome of children with MIS-C, seen in two, private, urban, tertiary hospitals. Methodology: This is a retrospective, descriptive study of all consecutive MIS-C cases, using the 2020 US CDC definition, seen between July 2020 to January 2023, by a single infectious disease physician. Demographic, epidemiologic, clinical, and physical examination findings; results of laboratory, 2-DE, and radiologic tests; co-illnesses and complications; and therapeutic and outcome data, were entered in a case report form for each patient. Results: Thirty-six patients were seen. MIS-C cases had a median age of 6 years, presented with fever in 97%, while one-half had abdominal pain, vomiting, diarrhea and/or rash. CRP, D-dimer, ferritin, LDH and procalcitonin were generally elevated, and thrombocytopenia was seen in 39%. The most common 2-DE abnormalities were pericardial effusion (50%), coronary artery dilatation or aneurysm (39%) and mitral regurgitation (36%); the 2-DE was normal in 22%. The main complications were pneumonia (31%), myocarditis (28%) and hypotension (14%); 8% had ARDS. Treatment was with corticosteroids (89%) and IVIG (84%). Most (94%) recovered, and the hospital stay was five days, or less, in 86%. The two mortalities were a severely wasted adolescent with previously undiagnosed HIV infection; and an adolescent on chemotherapy for AML, who was also being treated for disseminated TB. Conclusions: There is a need to create a greater awareness of MIS-C as, like Kawasaki disease, it has the potential to be an important cause of acquired heart disease among children.