Cardiac Implication in Pediatric Multisystemic Inflammatory Syndrome – Three Case Reports and Review of the Literature

Pediatric multisystem inflammatory syndrome (PMIS) appears to be a relatively rare complication of COVID-19 in children, occurring in less than 1% of children with confirmed SARS-CoV-2 infection. This condition can appear several weeks after the acute SARS-CoV-2 infection and is assumed to be a delayed immune response to coronavirus disease 2019 which can lead to a severe cardiovascular involvement. In this retrospective study, our main purpose was to summarize the clinical data from three types of onsets in patients diagnosed with PMIS and report the experience to the known data in the literature. We put the emphasis on the course of management considering the three different presenting faces of the PMIS in children. All patients received IV immunoglobulin and antiplatelet treatment, 66% (2 of 3) necessitated inotropic support, corticosteroid therapy (metilprednisolon), anticoagulation, 33% (1 of 3) received Anakinra (antagonist of the interleukin 1 receptor). All of them received cardiac remodeling treatment with Lisinopril and Bisoprolol (associated or not with Spironolactone and Furosemide). Evolution was good with discharge in approximately 2 weeks from admission, without symptoms, and with cardiac improvement at echocardiography. PMIS is an alarming situation that necessitate multidisciplinary approach and a complex management. The cardiac evaluation is crucial in risk evaluation and guidance for a correct approach of the disease.