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Background: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic. Materials and methods: Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India. Results: We identified 120 patients [median age: 7 years (interquartile range (IQR): 4-10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (n = 63), MIS-C with Kawasaki disease (KD) (n = 23), and MIS-C without shock and KD (n = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5-212.5) and ferritin was 543 ng/mL (IQR, 225-1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity. Conclusion: MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C. [ABSTRACT FROM AUTHOR]

Covid-19 is generally a mild disease in children. Coinciding with the peak of the pandemic many children have been reported with a severe disease syndrome comprising fevers, shock with hyper-inflammation, and multiorgan dysfunction, now named pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2-(CoV-2). Although initially thought to be a spurt in cases of Kawasaki Disease (KD) the clinical manifestations differ from KD in being more common in older children with more severe derangements of inflammatory markers and cardiac dysfunction. Gastrointestinal symptoms are prominent. This is likely a postinfection hyper-inflammatory response as almost 90% test positive for antibodies against CoV-2 with significantly raised inflammatory markers and cytokine levels. Most children require cardiovascular and respiratory support and vasoactive therapy in intensive care units. Extracorporeal support is occasionally needed. Intravenous immunoglobulin, aspirin, and steroids are the cornerstones of therapy, though some refractory cases require immune-modulating agents. With adequate treatment, most have shown a favorable outcome. [ABSTRACT FROM AUTHOR]

Multiple lung abscesses are extremely rare in healthy children. We report a case of polymicrobial bilateral lung abscess in a 9-month-old previously well infant presenting with a short history of fever and respiratory distress. The management options and outcome are discussed. [ABSTRACT FROM AUTHOR]