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GI signs and symptoms appear prominently as presenting features of multisystem inflammatory syndrome in children.
GI symptoms were a presenting symptom in 84.1% of cases and were most often accompanied by fever (100%) and rash (70.5%). In contrast to adults presenting with COVID-19, only 25% of children required supplemental oxygen. In all, 29.5% had presented within 7 days prior to admission at an emergency room or urgent care center for less severe symptoms such as fever and GI symptoms mimicking a viral gastroenteritis (eg, nausea, vomiting, diarrhea) but without other systemic symptoms.
– Omar Khan, MD
This abstract is available on the publisher's site.
Until recently, the clinical course of coronavirus disease 2019 (COVID-19) in children has been reported to be largely mild.1,2 Recently, it has become evident that a subset of children exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can become critically ill with a condition now referred to as multisystem inflammatory syndrome in children (MIS-C), characterized by systemic hyperinflammation with fever and multi-system organ dysfunction.3 Gastrointestinal symptoms are increasingly recognized to be associated with the presentation of MIS-C, potentially confusing the diagnosis of MIS-C with other common, less toxic gastrointestinal infections and even inflammatory bowel disease. In the first published correspondence describing MIS-C in eight patients from the United Kingdom, 100% presented with GI symptoms.4 Similarly 6 of 10 patients from an Italian cohort had GI issues.5 This is in contrast to adults, who most commonly present with respiratory symptoms, and report GI symptoms in <10-15% of cases.6,7 We examined whether similar presentations and prevalence extended to our comparatively larger U.S. cohort of 44 patients (<21 years old) with MIS-C.