Clinical presentation and short-term outcomes of multisystemic inflammatory syndrome in children in Lagos, Nigeria during the COVID-19 pandemic: A case series

Background Multisystemic inflammatory syndrome in children (MIS-C) has increasingly been documented globally with the progression of the COVID-19 pandemic and a significant proportion of cases have been noted in children of Black descent. There has been a noticeable discrepancy in the presentation and outcomes of COVID-19 infection in sub-Saharan Africa compared to the rest of the world. We documented the demography, clinical features, laboratory and imaging findings, therapeutic management, and short-term outcomes of paediatric patients with MIS-C diagnosed during the COVID-19 pandemic in Lagos, Nigeria. Methods We carried out a retrospective review of MIS-C cases seen in nine public and private hospitals in Lagos from July 10, 2020 to July 30, 2021. Data on clinical presentation, laboratory investigations, therapy as well as outcomes at 2 weeks, 6 weeks, 3 months and 6 months were analyzed. Findings 28 children and adolescents with median age of 7.5 (IQR 2.3 - 9.4) years were diagnosed with MIS-C. MISC was suspected in 24 patients (85.7%) at initial clinical evaluation and mucocutaneous, gastrointestinal and cardiovascular manifestations were identified in 75.0%, 71.4% and 89.3% of patients respectively. Acute kidney injury and aseptic meningitis were noted in 32.1% and 17.9% of patients respectively. Cardiac manifestations at presentation included coronary dilatation and pericardial effusion in 46.4% each, ventricular dysfunction (32.1%), atrioventricular valve regurgitation (25.0%), prolonged QTc interval (40.0%) and first-degree atrioventricular block (16.0%). Therapy included aspirin in 89.3%, steroids in 75.0% and intravenous immunoglobulin (IVIG) infusion in 60.7%. All patients survived and were discharged after a mean of 11.14 (SD 5.65) days. Frequency of coronary dilatation had reduced from 46.4% to 7.1% by 3 months follow up and prolonged QTc interval persisted until the 6 week follow up in 4.5% of patients. Echocardiogram and electrocardiogram findings were normal in all patients assessed at 6 months follow up. Interpretation MIS-C is an important diagnosis in children presenting with prolonged fever during the COVID-19 pandemic. Cardiovascular manifestations occurred in several children with MIS-C and improved by 6 months follow up. Early diagnosis and prompt institution of a combination of antiplatelet therapy, steroids and IVIG appear to be beneficial.