LETTER TO THE EDITOR


https://doi.org/10.5005/jp-journals-10071-23927
Indian Journal of Critical Care Medicine
Volume 25 | Issue 8 | Year 2021

MIS-C is a Clinically Different Entity from Acute COVID-19 in Adults

Bharat Mehra1 https://orcid.org/0000-0001-8194-7623, Vyom Aggarwal2 https://orcid.org/0000-0003-4767-0346, Praveen Kumar3 https://orcid.org/0000-0002-9172-2767, Dhiren Gupta4 https://orcid.org/0000-0002-8244-0768, Mohan Kundal5 https://orcid.org/0000-0003-3480-5459, Arun Kumar6 https://orcid.org/0000-0001-7102-3136, Sandeep K Dugaya7 https://orcid.org/0000-0003-2154-6144

1Department of Pediatric Intensive Care, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India

2,5–7Department of Pediatrics, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India

3,4Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India

Corresponding Author: Bharat Mehra, Department of Pediatric Intensive Care, Max Super Speciality Hospital, Shalimar Bagh, Delhi, India, Phone: +91 9999538720, e-mail: bharatmehra909@gmail.com

How to cite this article: Mehra B, Aggarwal V, Kumar P, Gupta D, Kundal M, Kumar A, et al. MIS-C is a Clinically Different Entity from Acute COVID-19 in Adults. Indian J Crit Care Med 2021;25(8):954–955.

Source of support: Nil

Conflict of interest: None

 

Keywords: Acute disseminated encephalomyelitis (ADEM), Guillain Barre Syndrome, Multisystem inflammatory syndrome children (MIS-C).

 

We appreciate the authors for their interest in our case report and are thankful for their critical appraisal. They have expressed their reservations about some statements made in the text, but it seems they have missed the actual timeline, sequence of events, and the already-embedded information in the original text.1 We have tried to clarify all the concerns raised, with special reference to the timeline of events.

At the outset, we would like to emphasize that the index case is about “multisystem inflammatory syndrome in children (MIS-C),” which is a clinical entity different from “acute COVID-19” as seen and described in adults. MIS-C usually represents a postinfectious, immune-mediated complication, occurring 2 to 6 weeks after primary exposure (as happened in our case), rather than an acute infection.2 The knowledge and understanding of MIS-C is gradually evolving over the last 1 year. The main purpose of our case report was to highlight the “severe” neurological insult involving “both central and peripheral nervous system” as a spectrum of MIS-C, which has been rarely reported in the literature available till date.

Table 1: Reference values of laboratory parameters
Normal range Normal range
Hemoglobin (gm/dL) 12–15 C-reactive protein (mg/dL) 0–0.5
Total leukocyte count (×109 cells/L) 4.0–10.0 IL-6 (pg/mL) 0–7
Platelet (×109 cells/L) 150–410 Ferritin (ng/mL) 11–306
S. urea (mg/dL) 15–38 D-dimer (ng/mL) 0–243
S. creatinine (mg/dL) 0.26–0.77 Fibrinogen (mg/dL) 238–498
SGOT (IU/L) <50 Triglycerides (mg/dL) <150
SGPT (IU/L) <50 Troponin-I (ng/mL) 0–0.04
Total bilirubin (mg/dL) 0.3–1.2 NT-proBNP (pg/mL) 0–450
Direct bilirubin (mg/dL) 0.1–0.5 LDH (U/L) 98–192
S. albumin (gm/dL) 3.5–5.0

ORCID

Bharat Mehra https://orcid.org/0000-0001-8194-7623

Vyom Aggarwal https://orcid.org/0000-0003-4767-0346

Praveen Kumar https://orcid.org/0000-0002-9172-2767

Dhiren Gupta https://orcid.org/0000-0002-8244-0768

Mohan Kundal https://orcid.org/0000-0003-3480-5459

Arun Kumar https://orcid.org/0000-0001-7102-3136

Sandeep K Dugaya https://orcid.org/0000-0003-2154-6144

REFERENCES

1. Mehra B, Aggarwal V, Kumar P, Kundal M, Gupta D, Kumar A, et al. COVID-19 associated severe multisystem inflammatory syndrome in children with encephalopathy and neuropathy in an adolescent girl with the successful outcome: an unusual presentation. Indian J Crit Care Med 2020; 24(12):1276–1278. DOI: 10.5005/jp-journals-10071-23685.

2. Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int 2021; 41(1):19–32. DOI: 10.1007/s00296-020-04749-4.

3. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol 2019; 15(11):671–683. DOI: 10.1038/s41582-019-0250-9.

4. Lee YJ. Acute disseminated encephalomyelitis in children: differential diagnosis from multiple sclerosis on the basis of clinical course. Korean J Pediatr 2011; 54(6):234–240. DOI: 10.3345/kjp.2011.54.6.234.

5. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet 2021;397(10280):1214–1228. DOI: 10.1016/S0140-6736(21)00517-1.

6. Alsaied T, Tremoulet AH, Burns JC, Saidi A, Dionne A, Lang SM, et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation 2021; 143(1):78–88. DOI: 10.1161/CIRCULATIONAHA.120.049836.

7. Dionne A, Dahdah N. A decade of NT-proBNP in acute Kawasaki disease, from physiological response to clinical relevance. Children 2018; 5(10):141. DOI: 10.3390/children5100141.

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