A comparison of pediatric inflammatory multisystem syndrome temporarily-associated with SARS-CoV-2 and Kawasaki disease
Markus Hufnagel, Jakob Armann, André Jakob, Maren Doenhardt, Natalie Diffloth, Anton Hospach, Dominik T. Schneider, Andreas Trotter, Martin Roessler, Jochen Schmitt, Reinhard Berner, The PIMS-DGPI Working Group, Grazyna Adamiak-Brych, Martina Aderhold, Sara Aggar, Mohammed-Ahmed Ahmed, Sandra Akanbi, Kristin M. Anders, Stefan Arens, Jakob Armann, Christoph Baßmann, Lisa Baumbach, Otto-Jonas Bayrhof, Gerald Beier, Ardua Berger, Daniel Bernard, Reinhard Berner, Mario Berwald, Adina Biering, Ulrike Blümlein, Stefanie Blume, Kai Böckenholt, Carsten Bölke, Thomas Boesing, Robert Bonacker, Monika-Maria Borchers, Britta Brenner, Folke Brinkmann, Jasmin Brühler, J. Brünner, Laura Buchtala, Jörg Budde, Reinhard Bullmann, Marc Carré Schoppe, Gordana Cvetanovic, Alina Czwienzek, Metin Degirmenci, Fenja Dejas, Bergüzar Demirdelen, Anke Diederichs, Maren Dittrich, Katharina Döhring, Helena Donath, Franziska Ebert, Annemarie Eff, Kerstin Ehrentraut, Fiene Eißler, Anne Eißner, Elisa Endres, Matthias Engler, Andreas Fiedler, Karin Fingerhut, Agnes Finster, Doris Fischer, Simon Flümann, Svenja Foth, Christian Fremery, Holger Frenzke, Lukas Galow, Monika Gappa, Stephan Gerling, Stina Gitzinger, Nicola Glaser, Karoline Goj, Sarah Goretzki, Katrin Gröger, Tim Groteclaes, Judith Grüner, Mike Grünwedel, Stephan Haag, Lisa Hacker, Nikolaus Halwas, Christof Hanke, Anne Haupt, Christina Heinrich, Julia Heinrich, Lutz Hempel, Matthias Hermann, Matthias Herzog, Georg Heubner, Georg Hillebrand, Matthias Himpel, Kai-Alexandra Hilker, Cara Hittmeyer, A. Höche, Mirjam Höfgen, Uwe Höpner, Katharina Holtkamp, Thomas Hoppen, Marita Horstkemper
Abstract
The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4-11] vs. 3 [IQR 1-4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae-mainly cardiovascular-were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.