Table 1: Clinical features, treatment and outcome of

multisystem inflammatory syndrome in children in patients with G6PD deficiency.

 

Age

(years)

Sex

Days

of

fever

Mucocutaneous

signs

System

involved

Laboratory tests

Echocardiography

Treatment

Outcome

Almoosa9

7

Female

3

Rash

G-I, CNS

RT-PCR (+)

Normal

AB, IVIG, DXM, favipiravir, LMWH

Recovery

on 6 day

Al-Aamri8

10-15

Female

3

KD

G-I, shock, myocarditis, ARDS, AKDI

Anemia, hyponatremia, hypoalbuminemia, ferritin, creatinine and serum glucose ↑

LDH, total serum bilirrubin, and AST/ALT ↑

Mild pericardial effusion, mild regurgitation mitral, moderate to severe left ventricular dysfunction and dilatation

AB, IVIG, MPD, favipiravir, aspirin, tocilizumab, enoxaparin, inotropic therapy

Death

on 10 day

Almoosa9

11

Male

3

Conjunctivitis

Rash

Cracked lips

and strawberry

tongue

G-I, shock.

Anemia, thrombocytopenia, hyponatremia, hypoalbuminemia

Troponin, BNP and DD ↑

Biomarkers inflammatory ↑

(ESR, CRP, ferritin), COVID-19 antibody IgG (+)

Normal

IVIG, MPD

Recovery

Almoosa9

13

Female

5

Conjunctivitis

Rash

Erythematous cracked lips

Extremity

edema

G-I, Shock, myocarditis, coagulopathy, ARDS

Biomarkers inflammatory ↑

(ESR, CRP), leukocytosis, hyponatremia, cardiac enzymes (BNP, troponin) ↑

RT-PCR and IgG SARS-CoV-2 (+)

Mild pericardial effusion, mild mitral regurgitation, depressed left ventricular function

AB, IVIG, MPD, favipiravir, tocilizumab, LMWH, inotropic and pressor therapy

Death

on day 6

Al Ameer7

13

Female

5

Conjunctivitis

Rash

Erythematous cracked lips

G-I, shock, myocarditis, ARDS, AKDI, liver failure, ventricular dysfunction

Biomarkers inflammatory ↑ (ESR, ferritin), leukocytosis, anemia, hyponatremia, hypoalbuminemia, cardiac enzymes ↑

RT-PCR and IgG SARS-CoV-2 (+)

Mild pericardial effusion, mild mitral regurgitation, moderate depression in left ventricular function (LVEF 32%)

AB, IVIG, MPD, favipiravir, tocilizumab, anticoagulant therapy, inotropic and pressor therapy

Death

on day 15

G-I = gastrointestinal;

CNS = central nervous system;

RT-PCR = real-time polymerase chain reaction;

AB = antibiotic;

IVIG: intravenous immunoglobulin;

DXM = dexamethasone;

LMWH = low molecular weight heparin;

KD = Kawasaki disease;

ARDS = acute respiratory distress syndrome;

AKDI = Acute Kidney Disease Injury;

MPD = methylprednisolone;

LDH = lactate dehydrogenase;

AST/ALT = asparate aminotransferase/alanine transaminase;

BNP = brain natriuretic peptide;

DD = D-dimer;

ERS = erythrocyte sedimentation rate;

CRP = C-reactive protein;

LVEF = left ventricular ejection fraction.